Leukocytapheresis for the treatment of hyperleukocytosis secondary to acute leukemia

Abstract

Patients presenting with new or recurrent acute leukemia, particularly of the myeloid lineage, with WBC counts exceeding 100 ϫ 10 9 /L are often considered for leukocytapheresis, especially if they are experiencing symptoms of leukostasis. These symptoms are thought to occur because of blast aggregates and WBC thrombi in the circulation, which reduce blood flow. Leukostasis may cause various complications, including hyperviscosity syndrome, vascular occlusion resulting in intracranial hemorrhages and respiratory failure, and perivascular leukemic infiltrates. Leukostasis occurs more commonly with a high WBC count and with leukemias of monocytoid lineage such as acute myelomonocytic leukemia, which is a reflection of the nature of the leukemic blasts. Leukocytapheresis is used in an effort to quickly decrease a patient's circulating blast count, which can both prevent the development of leukostasis and provide symptomatic relief of leukostasis. However, the impact of leukocytapheresis on early-and long-term mortality is controversial, with several studies producing conflicting results. In this chapter, the pathophysiology of leukostasis, performance of leukocytapheresis, and efficacy of this treatment are reviewed. Learning Objective• To gain an understanding of the pathophysiology of leukostasis and the role of leukocytapheresis as a therapeutic invention

Leukostasis-Related Fatal Cardiopulmonary Arrest as Initial Chronic Myeloid Leukemia Presentation

“…Leukostasis is rare in both CML (in CP or AP) and CLL. In CML patients, leukostasis occurs more often in blast crisis or when total WBC count exceeds 300,000/ µL [6,7].…”

Long term impact of hyperleukocytosis in newly diagnosed acute myeloid leukemia patients undergoing allogeneic stem cell transplantation: An analysis from the acute leukemia working party of the EBMT

“…Patients presenting in like fashion are treated emergently as a substantial body of evidence published over the past three decades conclusively shows that these patients are at a significant risk for early death during initial induction therapy . Risk factors for hyperleukocytosis (HL) include younger age and leukemias skewed toward monocytic differentiation . Central to the pathogenesis of the increased mortality seen in hyperleukocytosis patients are the aggregate detrimental effects of leukostasis, tumor lysis syndrome, and disseminated intravascular coagulation.…”

Therapeutic leukapheresis in a tertiary care hospital: A case series

“…[67] The symptoms suggestive of leukostasis are confusion, dizziness, headache, tinnitus, visual disturbances such as blurred vision, mental status change like stupor, delirium, coma or respiratory symptoms such as dyspnea, tachypnea, and hypoxemia. [7]…”