Leukocyte Depletion by Therapeutic Leukocytapheresis in Patients with Leukemia

Abstract

Hyperleukocytosis is a complication of various leukemias and can result in life-threatening leukostasis. Critical white blood cell (WBC) counts are conventionally defined as higher than 100 × 10⁹/l in acute myeloid leukemia and > 300 × 10⁹/l in acute lymphatic leukemia and other leukemic disorders (e. g. chronic myeloid leukemia). Leukocytapheresis is a therapeutic tool to reduce leukocyte counts in patients with symptomatic or threatening leukostasis until induction chemotherapy works. In patients with temporary contraindications against cytotoxic drugs, e.g. during pregnancy, leukocytapheresis can be used as a bridging therapy until conventional chemotherapy can be started. Therapeutic leukocytapheresis should be performed in specialized centers by experienced, well-trained staff. Thorough monitoring of the patients is extremely relevant. During a single procedure, WBC count can be reduced by 10–70%. Treatment should be repeated daily and can be discontinued when the symptoms of leukostasis have been resolved and/or leukocyte counts have fallen below the critical thresholds. There are no prospective studies evaluating the clinical efficacy of therapeutic leukocytapheresis in patients with hyperleukocytosis. It can be concluded from retrospective studies that leukocytapheresis might have some beneficial effect in early morbidity and mortality of patients with newly diagnosed AML but has no influence on overall long-term survival. Induction chemotherapy is the most important treatment in these patients and must never be postponed.

Splenic infarct presenting as acute chest pain

“…Patients with symptoms refractive to conservative treatment generally undergo splenectomy. Close monitoring with focus on cardiovascular status is critical in early detection and intervention of known complications of SI, which include the following: splenic rupture, hemorrhage, abscess, or pseudocyst [15][16][17][18][19][20]. Treatment specific to underlying etiology for SI is also of paramount importance.…”

Treatment in adult patients with acute myeloid leukemias with hyperleukocytosis at disease onset

“…Для этой цели в настоящее время применяют как медикамен-тозное воздействие, способствующее разрушению опухо-левых клеток (в частности, гидроксимочевину), так и лей-коцитафераз (лейкоцитобластаферез) для механического их удаления. Целесообразность и эффективность того или иного метода циторедукции активно обсуждается в лите-ратуре [1,[6][7][8][9][10][11]. Однако нет больших проспективных ис-следований, оценивающих клиническую эффективность терапевтических лейкоцитаферезов у больных с ГЛ.…”

“…Однако нет больших проспективных ис-следований, оценивающих клиническую эффективность терапевтических лейкоцитаферезов у больных с ГЛ. Ос-новываясь на ретроспективных данных, большинство ис-следователей склоняется к необходимости проведения лейкоцитаферезов при гиперлейкоцитозных формах ОЛ, что позволяет уменьшить риск развития тяжелого синдро-ма массивного опухолевого распада и раннюю леталь-ность [6]. В то же время в литературе имеются ретроспек-тивные исследования, в которых не выявлены различия в выживаемости больных в период индукции и на отдален-ных этапах терапии как при использовании гидроксимо-чевины, так и после лейкоцитаферезов в сравнении с историческим контролем [7,8].…”

Leukocytapheresis for the treatment of hyperleukocytosis secondary to acute leukemia

“…Vascular complications are also associated with leukostasis: priapism, myocardial ischemia/ infarction, and retinal hemorrhage/thrombosis. 4,6,7 Patients with acute leukemia who present with hyperleukocytosis and symptoms of leukostasis have a poor prognosis, with mortality primarily due to intracranial hemorrhage and respiratory failure. [8][9][10] This appears to be especially true with AML, in which symptoms of leukostasis can manifest in patients with WBC counts as low as 50 ϫ 10 9 /L.…”

“…16 A complete blood count (CBC) should be obtained before beginning the procedure, at the midway point to assess progress in reducing the WBC count and to monitor hemoglobin, and upon completion of leukocytapheresis. 7,11 Additional leukocytapheresis procedures may be undertaken if clinically indicated to improve symptoms of leukostasis. 16,17 Adverse reactions Citrate (acid citrate dextrose) is the anticoagulant most commonly used to prevent clotting of the apheresis circuit.…”