Leukostasis in adult acute hyperleukocytic leukemia: a clinician's digest

Abstract

Leukostasis is a poorly understood and life-threatening complication of acute hyperleukocytic leukemia. The incidence of hyperleukocytosis and leukostasis differs among various subtypes of leukemias. While the pathophysiology of leukostasis is not fully understood, recent research has elucidated many novel pathways that may have therapeutic implications in the future. Respiratory and neurological compromise represents the classical clinical manifestations of leukostasis. If it is not diagnosed and treated rapidly, the one-week mortality rate is approximately 40%. Targeted induction chemotherapy is an important component of the successful treatment of leukostasis, although other modalities of cytoreduction are being used and investigated.

The effect of therapeutic leukapheresis on early complications and outcomes in patients with acute leukemia and hyperleukocytosis: a propensity score‐matched study

“…4,5 Another proposed mechanism for its pathogenesis includes interactions between leukemic blasts and the endothelium or the activation of endothelial cells by leukemic blast-secreted cytokines. 2,[6][7][8] Clinically, leukostasis could be diagnosed by characteristic respiratory or neurologic symptoms in patients with acute leukemia and hyperleukocytosis. However, the clinical and radiographic manifestations of leukostasis are difficult to distinguish from other complications of acute leukemia.…”

“…However, the clinical and radiographic manifestations of leukostasis are difficult to distinguish from other complications of acute leukemia. 2,6 TLS is characterized by hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia as a result of spontaneous or treatment-induced leukemic blast destruction. 9,10 Such complications can lead to acute renal failure, cardiac arrhythmia, seizures, and sudden death.…”

“…Clinically, leukostasis could be diagnosed by characteristic respiratory or neurologic symptoms in patients with acute leukemia and hyperleukocytosis. However, the clinical and radiographic manifestations of leukostasis are difficult to distinguish from other complications of acute leukemia …”

Fatal right‐sided heart failure due to leukostasis in a patient with leukemic transformation of myelodysplastic syndrome

“…2 Also, a role for adhesion receptors and cytokines has been suggested as a pathogenic factor. 4 One-week mortality of leukostasis is 20%-40% if left untreated and rises to 90% with the presence of respiratory failure and neurological compromise. 1 We present a case in which transformation to AML leads to acute fatal right-sided heart failure in a patient with myelodysplastic syndrome (MDS).…”

Leukostasis: Management to Prevent Crisis in Acute Leukemia

“…The first centers on the idea that with a higher than normal degree of viscosity, stasis can occur in microvasculature, resulting in organ damage (Ali, Mirrakhimov, Abboud, & Cashen, 2016;Jain, Bansal, & Marwaha, 2013;Ruggiero et al, 2016;Schiffer, 2016;Shiber & Fines, 2011;Stucki et al, 2001). If the leukocrit, or fractional volume of leukocytes, is greater than 12-15 ml/dl, a significant rise in blood viscosity can occur (Ali et al, 2016). The leukocrit is the volume percentage of leukocytes in whole blood, which is twice as high in leukemic myeloblasts than in the leukemic lymphoblasts.…”