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Hyperleukocytosis (HL) is defined by a white blood cell (WBC) count of > 50 × 109/L or > 100 × 109/L.1 HL is associated with poor outcome in patients with acute myeloid leukemia (AML) because of complications, such as leukostasis, tumor lysis syndrome (TLS) and disseminated intravascular coagulopathy (DIC).1 HL associated with leukostasis requires immediate treatment, with options such as leukapheresis, intensive chemotherapy (IC), and hydroxyurea.2
Limited data are available on short- and long-term outcomes of patients with HL, and the impact of leukapheresis on clinical outcomes is not well defined. In this large, international, retrospective study recently published in Leukemia, Maximilian Stahl and colleagues aimed to evaluate the impact of hyperleukocytosis, leukostasis, and leukapheresis on short- and long-term clinical outcomes in newly diagnosed patients with AML.3
Table 1. Patient characteristics
DIC, disseminated intravascular coagulopathy; IQR, interquartile range; TLS, tumor lysis syndrome |
||||
Characteristics |
All |
No leukapheresis |
Leukapheresis |
p value |
---|---|---|---|---|
Median age, years (IQR) |
55 (41–66) |
55 (42–66) |
55 (38–65) |
0.459 |
Median WBC (IQR) |
110 × 109/L (77–170) |
103 × 109/L (73–152) |
175 × 109/L (127─246) |
< 0.001 |
Favorable cytogenetic risk |
23.6% |
27.6% |
2% |
< 0.001 |
Intermediate cytogenetic risk |
59.8% |
56.5% |
77.2% |
< 0.001 |
Unfavorable cytogenetic risk |
16.6% |
15.9% |
20.8% |
< 0.001 |
Leukostasis |
27.2% |
22.1%, |
55.9% |
< 0.001 |
TLS |
28.2% |
29.3% |
20.8% |
0.09 |
DIC |
18.2% |
17.8% |
20.4% |
0.566 |
Table 2. Clinical outcomes
CI, confidence interval; CR, complete response; CRi, complete response with incomplete count recovery; IQR, interquartile range; PR, partial response; OS, overall survival |
||||
Outcomes |
All |
No leukapheresis |
Leukapheresis |
p value |
---|---|---|---|---|
Death in the first 30 days |
16.7% |
17.3% |
13.2% |
0.329 |
Response CR CRi PR No response |
50.4% 13.7% 3.8% 32.1% |
51.5% 12.8% 3.2% 32.5% |
43.5% 19.4% 7.4% 29.6% |
0.036 |
Median duration of CR, days (IQR) |
202 (114─363) |
208 (133─368) |
171 (78─280) |
0.192 |
Relapse |
42.6% |
38.8% |
63.8% |
< 0.001 |
Median OS, months (95% CI) |
12.6 (11.5─14.9) |
12 (10.4─13.9) |
18.8 (13.3─32.5) |
0.07 |
The results of this study, from one of the largest cohorts of patients with AML and hyperleukocytosis, showed that
The definition of leukostasis is one limitation of this study. Due to the absence of diagnostic tests, leukostasis was defined by the investigators based on clinical symptoms, thus patients might have been incorrectly assigned to this group. Because of this issue, plus the small number of patients with leukostasis, the benefit of leukapheresis on the short and long-term clinical outcomes of this sub-population was not well defined. Randomized studies are needed to define the impact of leukapheresis on the outcome of patients with AML and hyperleukocytosis.
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