Leukodepletion for acute lymphocytic leukemia in a three-week-old infant

We report the smallest infant (4.5 kg) to receive leukapheresis as an immediate treatment for Infantile Acute Lymphocytic Leukemia. Leukodepletion helps prevent the risks of hyperviscosity and cerebrovascular and pulmonary leukostasis. In addition, it is a desirable precursor to chemotherapy to potentially reduce metabolic and renal complications associated with rapid cell lysis. Because of this infant's small size, she presented us with multiple concerns, including hypocalcemia from citrate anticoagulation, extracorporeal volume and fluid balance, inlet flow rates. and establishment of adequate interface. Our positive experience in performing this procedure suggests that cytapheresis is a feasible treatment even for very young infants.