Management of Hyperleukocytosis and Results of Leukapheresis in Childhood Acute Leukemia: A Single Center Experience

Abstract

Background Hyperleukocytosis in pediatric acute leukemia is associated with increased morbidity and mortality. Objectives The aim was to review the clinical characteristics and outcomes of patients with newly diagnosed leukemia with hyperleukocytosis (HL). Methods A retrospective case control study reviewed data from a single institution over a 5-year period. Hyperleukocytosis was present in 41 patients with acute leukemia and were included in the study. Treatment strategies included hyperhydration, administration of allopurinol or rasbirucase, early induction of induction chemotherapy (CT), and leukapheresis (LP). Results Twenty seven (65.9%) of the 41 patients were male and the median age was 7 (range 1–17) years. Rasburicase was only used in 6 acute lymphocytic leukemia (ALL) patients with hyperuricemia. LP was used in 9 of 41 (13%) patients with hyperleukocytosis and a total of 25 LP procedures were performed. The mean leukocyte value after apheresis was 65,529/mm3. In patients with and without LP, tumor lysis syndrome was seen in 2 (23%) and 2 (6.25%) patients, respectively. Pulmonary leukostasis was seen in 2 patients, one of whom underwent LP. The mean leukocyte count in patients who received LP versus those who did not was 520,000 cells/mm3 and 158,800 cells/mm3, respectively. The time from presentation to the initiation of CT was the same between those who received LP and those who did not (mean of 35 h vs. 34 h). During the first 14 days after presentation, cerebral leukostasis/coagulopathy or pulmonary leukostasis-related early death did not occur in patients with leukemia. Conclusions The use of LP in patients with hyperleukocytosis is safe and effective, well tolerated and does not alter time to CT induction at our institution.