Therapeutic leukocytapheresis for improvement in respiratory function in a woman with hyperleukocytosis and mantle cell lymphoma with a circulating small lymphocyte phenotype

Abstract

Mantle cell lymphoma is an aggressive malignant B-cell disorder that often presents with a leukemic picture. Circulating lymphoma cell morphology may vary from small round mature-appearing lymphocytes resembling the lymphocytes of chronic lymphocytic leukemia to large prolymphocytoid or blastoid cells. Rare reports of hyperleukocytosis with leukostasis, treated with leukocytapheresis, are described in patients with prolymphocytoid or blastoid morphology. We report an 88 year old woman with mantle cell lymphoma, hyperleukocytosis (WBC > 400 × 10(3) /µL) with severe respiratory compromise but without interstitial or alveolar infiltrates on radiograph or computerized tomography of the chest. She was afebrile and had no central nervous system signs. Circulating lymphoma cell morphology was predominantly of the small lymphocyte type. A two-whole-blood-volume leukocytapheresis reduced her WBC from 465 to 221 × 10(3) /µL in 150 min. Her respiratory rate decreased from 28/min to 18/min and her arterial oxygen saturation (SpO2 ) rose from 91% to 97% on 6 L/min of oxygen by nasal cannula. Severe breathlessness before the procedure abated completely by the end of the procedure. Respiratory compromise may occur in mantle cell lymphoma with hyperleukocytosis with a mature lymphoma cell phenotype, even without a clear picture of leukostasis. Although the ultimate survival of the patient depends on treatment with chemotherapy, leukocytapheresis for alleviation of symptoms may be warranted and should be considered. Respiratory status and response to leukocytapheresis should be documented with physiological measurements. J. Clin. Apheresis 31:398-402, 2016. © 2015 Wiley Periodicals, Inc.

Unclassifiable B-Cell Lymphoma With Symptomatic Hyperleukocytosis Managed With Leukapheresis

“…In conclusion, the role of therapeutic leukapheresis in non-Hodgkin lymphoma is not well studied and is mostly limited to case reports. 6 Nevertheless, emergent leukapheresis could be considered, as in our case, when a high clinical suspicion of hyperleukocytosis causing symptomatic end-organ dysfunction is suspected. More studies are needed to establish the specific criteria for leukapheresis in large B-cell lymphoma presenting with symptomatic hyperleukocytosis, ideal target WBC count post treatment, and the duration of treatment.…”

Repeated small-volume exchange transfusion for hyperleukocytosis in pediatric acute leukemia: A retrospective analysis

“…In most centers, leukapheresis is initiated in AML with PWBC >100 × 10 9 /L, while it is performed in ALL with PWBC of >300 × 10 9 /L ( 28 ). However, others consider the start time to be PWBC >200 × 10 9 /L and >400 × 10 9 /L for AML and ALL, respectively ( 29 ). It is debatable whether the above views are appropriate because all are based on a 70–100 mL/kg total blood volume for a single exchange transfusion.…”