High dose cyclophosphamide for cytoreduction in patients with acute myeloid leukemia with hyperleukocytosis or leukostasis

Zhao, Jennifer; Bewersdorf, Jan Philipp; Jaszczur, Sara Mohamed; Kowalski, Andrew S.; Perreault, Sarah; Schiffer, Molly; Gore, Steven D.; Podoltsev, Nikolai A.; Prébet, Thomas; Shallis, Rory M.

doi:10.1080/10428194.2020.1856835

Cited by 9 publications

(9 citation statements)

References 25 publications

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“…Leukapheresis was the subject of a multicentric retrospective study but showed no beneficial effects on mortality [ 18 , 19 ]. High dose cyclophosphamide has been shown to reduce early mortality but its long-term effects have not been studied [ 33 ]. Nonetheless, there are no strategies that have been shown to be superior to others and there is therefore a need for further study in this field.…”

Section: Discussionmentioning

confidence: 99%

Post-remission outcomes in AML patients with high hyperleukocytosis and inaugural life-threatening complications

et al. 2022

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Introduction Patients with hyperleukocytic (HL) acute myeloid leukemia (AML) are at higher risk of early death. Initial management of these patients is challenging, not fully codified and heterogenous. Retrospective studies showed that several symptomatic measures might decrease early death rate but long-term data are scarce. We aimed to analyze whether the therapeutic measures carried out urgently at diagnosis may influence the outcome among HL AML patients having achieved who survived inaugural complications. Methods We retrospectively reviewed all medical charts from patients admitted to Saint-Louis Hospital between January, 1st 1997 and December, 31st 2018 with newly diagnosed AML and white blood cell (WBC) count above 50x109/L. Outcome measures were cumulative incidence of relapse (CIR), treatment-related mortality (TRM) defined as relapse-free death, and overall survival. Univariate and multivariate analyses were performed using Cox proportional hazards models. Results A total of 184 patients with HL AML in complete remission (CR) were included in this study. At 2 years after CR. 62.5% of patients were alive, at 5 years, cumulated incidence of relapse was 55.8%. We found that every therapeutic measure, including life-sustaining therapies carried out in the initial phase of the disease, did not increase the relapse risk. The use of hydroxyurea for more than 4 days was associated with a higher risk of relapse. At the end of the study, 94 patients (51.1%) were still alive including 23 patients out of 44 aged less than 60 yo that were able to return to work. Conclusion We show that the use of emergency measures including life sustaining therapies does not come at the expense of a higher risk of relapse or mortality, except in the case of prolonged use of hydroxyurea. Patients with HL AML should be able to benefit from all available techniques, regardless of their initial severity.

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Section: Discussionmentioning

confidence: 99%

Post-remission outcomes in AML patients with high hyperleukocytosis and inaugural life-threatening complications

et al. 2022

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“…Hyperleukocytosis, typically defined as a leukocyte count ≥100 × 10 9 /L, occurs in 5% to 20% of patients with acute myeloid leukemia (AML) 1–11 . Hyperleukocytosis has been associated with a greater risk of early complications, such as leukostasis, disseminated intravascular coagulation, and tumor lysis syndrome (TLS) 1–13 .…”

Section: Introductionmentioning

confidence: 99%

“…Leukostasis is attributed to the high number of myeloblasts, which are larger and less deformable than mature leukocytes, thereby increasing the viscosity of the blood 1,2,5 . Additionally, myeloblasts release proinflammatory cytokines and upregulate adhesion molecules, which also play a role in how the leukocytes interact with the vascular endothelium, transmigrate into tissues, and reduce blood flow, leading to tissue damage 1,2,5,7 . Ultimately, leukostasis significantly increases the risk for ischemic tissue injury causing neurologic, pulmonary, and renal complications 5,9,10,14 .…”

Section: Introductionmentioning

confidence: 99%

“…Hyperleukocytosis, typically defined as a leukocyte count ≥100 � 10 9 /L, occurs in 5% to 20% of patients with acute myeloid leukemia (AML). [1][2][3][4][5][6][7][8][9][10][11] Hyperleukocytosis has been associated with a greater risk of early complications, such as leukostasis, disseminated intravascular coagulation, and tumor lysis syndrome (TLS). [1][2][3][4][5][6][7][8][9][10][11][12][13] Leukostasis is attributed to the high number of myeloblasts, which are larger and less deformable than mature leukocytes, thereby increasing the viscosity of the blood.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11] Hyperleukocytosis has been associated with a greater risk of early complications, such as leukostasis, disseminated intravascular coagulation, and tumor lysis syndrome (TLS). [1][2][3][4][5][6][7][8][9][10][11][12][13] Leukostasis is attributed to the high number of myeloblasts, which are larger and less deformable than mature leukocytes, thereby increasing the viscosity of the blood. 1,2,5 Additionally, myeloblasts release proinflammatory cytokines and upregulate adhesion molecules, which also play a role in how the leukocytes interact with the vascular endothelium, transmigrate into tissues, and reduce blood flow, leading to tissue damage.…”

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics and outcomes of children with newly diagnosed acute myeloid leukemia and hyperleukocytosis managed with different cytoreductive methods

Christakopoulos

Walker

Smith

et al. 2023

Cancer

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Background: Hyperleukocytosis in patients with acute myeloid leukemia (AML) has been associated with worse outcomes. For cytoreduction, leukapheresis has been used but its clinical utility is unknown, and low-dose cytarabine (LD-cytarabine) is used as an alternative method. Methods:Children with newly diagnosed AML treated between 1997 and 2017 in institutional protocols were studied. Hyperleukocytosis was defined as a leukocyte count of ≥100 � 10 9 /L at diagnosis. Clinical characteristics, early complications, survival data, and effects of cytoreductive methods were reviewed. Among 324 children with newly diagnosed AML, 49 (15.1%) presented with hyperleukocytosis. Initial management of hyperleukocytosis included leukapheresis or exchange transfusion (n = 16, considered as one group), LD-cytarabine (n = 18), hydroxyurea (n = 1), and no leukoreduction (n = 14). Results:Compared with patients who received leukapheresis, the percentage decrease in leukocyte counts following intervention was greater among those who received LD-cytarabine (48% vs. 75%; p = .02), with longer median time from diagnosis to initiation of protocol therapy (28.1 vs. 95.2 hours; p < .001). The incidence of infection was higher in patients (38%) who had leukapheresis than those who receive LD-cytarabine (0%) or leukoreduction with protocol therapy (14%) (p = .008). No differences were noted in the outcomes among the intervention groups. Although patients with hyperleukocytosis had higher incidences of pulmonary and metabolic complications than did those without, no early deaths occurred, and the complete remission, event-free survival, overall survival rates, and outcomes of both groups were similar. Conclusion:LD-cytarabine treatment appears to be a safe and effective means of cytoreduction for children with AML and hyperleukocytosis.

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Acute Chemotherapy Administration and Complications

Zhang,

Rivero

2024

Consulting Hematology and Oncology Handbook

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High dose cyclophosphamide for cytoreduction in patients with acute myeloid leukemia with hyperleukocytosis or leukostasis

Cited by 9 publications

References 25 publications

Post-remission outcomes in AML patients with high hyperleukocytosis and inaugural life-threatening complications

Post-remission outcomes in AML patients with high hyperleukocytosis and inaugural life-threatening complications

Clinical characteristics and outcomes of children with newly diagnosed acute myeloid leukemia and hyperleukocytosis managed with different cytoreductive methods

Acute Chemotherapy Administration and Complications

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