Pre‐chemotherapy white blood cell depletion by therapeutic leukocytapheresis in leukemia patients: A single‐institution experience

Abstract

Background: Hyperleukocytosis is commonly seen in acute and chronic leukemias. Therapeutic leukocytapheresis using an automatic cell separator can help to achieve prompt leukoreduction to reduce the rate of thrombotic events and early mortality as well as to prevent tumor lysis syndrome.Aim: In this study, we report a single center's experience in managing leukemia patients with therapeutic leukocytapheresis prior to chemotherapy. Materials and Methods: Leukocytapheresis procedures were performed in 192 leukemia patients (including acute myeloid leukemia [AML], acute lymphoblastic leukemia [ALL], and chronic myeloid leukemia [CML]) with hyperleukocytosis between January and December 2016.Results: Median % reduction of white blood cell (WBC) count was 30.5% and median % removal efficiency was 46.7% for 75 procedures where the waste bag was sampled. WBC removal efficiency strongly depended on diagnosis (and was 71%, 66%, and 39% for ALL, AML, and CML, respectively). Procedures were generally well tolerated with only 9 out of 192 patients having mild adverse effects. Discussion and Conclusion:In the absence of specific guidelines for the management of hyperleukocytosis, leukocytapheresis in association with chemotherapy should be considered early in clinical practice. K E Y W O R D Sacute lymphoblastic leukemia, acute myeloid leukemia, chronic myeloid leukemia, hyperleukocytosis

Impact of cervical cancer on the sexual and physical health of women diagnosed with cervical cancer in Ghana: A qualitative phenomenological study

“…The study finding is in consonance with the results of another study which identified that cancer patients experience low WBC count due to cancer medications thereby exposing them to frequent infection. 49 Termination of pregnancy was also a key finding in this study. Cervical cancer women in their reproductive age and who were fertile were worried that their fertility was terminated because of their condition.…”

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

“…20,21 Moreover, the use of leukapheresis is associated with several disadvantages, such as a need for the consultation process with an intensivist and blood bank staff, central venous line access, hypocalcemia resulting from the presence of citrate in blood products, decreased platelet counts, and overall excessive blood loss. [1][2][3][4]11,12 More recently, Zhao et al 7 showed that a single dose of high-dose cyclophosphamide (60 mg/kg) led to a sustained reduction in leukocyte counts in 75% of adult patients with AML with hyperleukocytosis or leukostasis. These studies provide important insight into management of patients with newly diagnosed leukemia and hyperleukocytosis.…”

“…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 .…”

“…Although leukapheresis and exchange transfusion have been widely used as cytoreductive procedures, these interventions have failed to demonstrate improvements in survival rates 16–19 or early adverse events 20,21 . Moreover, the use of leukapheresis is associated with several disadvantages, such as a need for the consultation process with an intensivist and blood bank staff, central venous line access, hypocalcemia resulting from the presence of citrate in blood products, decreased platelet counts, and overall excessive blood loss 1–4,11,12 . More recently, Zhao et al 7 .…”

“…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.…”