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

Ozlem Terzi

Background: Hyperleukocytosis in pediatric acute leukemia is associated with increased morbidity/mortality and there is no consensus on the use of Leukapheresis (LP) for its management. The aim was to review patients' clinical characteristics and outcomes 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 LP.

Results: Twenty seven (65.9%) of the 41 patients were male and the median age was 7 (range 1-17) years. 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 vs. those who did not was 520.000 cells/mm³ and 158.800 cells/mm³, respectively (p=0.01). The time from presentation to the initiation of CT was the same between those who received LP and those who did not (mean of 17 h and 18 h) (p>0.05). During the first 30 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.