Therapeutic leukapheresis in patients with leukostasis secondary to acute myelogenous leukemia

Abstract

Leukostasis is a relatively uncommon but potentially catastrophic complication of acute myelogenous leukemia (AML). Prompt leukoreduction is considered imperative to reduce the high mortality rate in this condition. Leukapheresis, usually associated with chemotherapy, is an established approach to diminish blast cell counts. We report a single center experience in managing leukostasis with leukapheresis. Fifteen patients with leukostasis of 187 patients with AML (8.02%) followed at our institution were treated with leukapheresis associated with chemotherapy. The procedures were scheduled to be performed on a daily basis until clinical improvement was achieved and WBC counts were significantly reduced. Overall and early mortalities, defined as that occurred in the first 7 days from diagnosis, were reported. A high proportion of our patients with leukostasis (46.66%) had a monocytic subtype AML (M4/M5, according to French-American-British classification). The median overall survival was 10 days, despite a significant WBC reduction after the first apheresis procedure (from 200.7 × 10⁹/L to 150.3 × 10⁹/L). Almost half of patients (7/15) had an early death. Therapeutic leukapheresis, associated or not to chemotherapy, is an effective approach to reduce WBC counts in patients with AML and leukostasis; however, this therapeutic procedure does not appear to change significantly the sombre prognosis observed in the majority of patients with this complication. Other forms of treatment must be found to reduce the high mortality rate related to leukostasis.

Leukapheresis in acute myeloid leukemia patients with hyperleukocytosis: A single center experience

“…They reported that the interaction between the leukemic cells and the vascular environment is probably more important in causing leukostasis than the absolute cell count itself. De Santis et al [20] performed 15 patients with leukostasis of 187 patients with AML. They treated them with leukapheresis associated with chemotherapy.…”

Hyperleukocytosis

“…Porcu et al ( 1997 ) similarly showed that effective leukapheresis did not impact early mortality in adult patients, especially those presenting with symptoms of leukostasis. Additional adult studies, mainly with AML patients, have had similar fi ndings (Tan et al 2005 ;Chang et al 2007 ;De Santis et al 2011 ). Others have found a signifi cant improvement in early death rate in adult AML cohorts receiving leukapheresis without impact on overall survival (Thiébaut et al 2000 ;Giles et al 2001 ;Bug et al 2007 ).…”

Leukocytapheresis for the treatment of hyperleukocytosis secondary to acute leukemia

“…1,2 Risk factors include younger age, certain cytogenetic abnormalities, and monocytic differentiation subtypes (acute myelomonocytic leukemia and acute monoblastic and monocytic leukemia). 2,3 Hyperleukocytosis can lead to leukostasis, tumor lysis syndrome, and disseminated intravascular coagulation (DIC). WBCs are not as deformable as RBCs, and viscosity increases logarithmically as the fractional volume of WBCs increases.…”