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Leukapheresis and exchange transfusion in children with acute leukemia and hyperleukocytosis. A single center
1Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany. roland.haase@medizin.uni-halle.de
Insights
Leukapheresis and exchange transfusion effectively reduced high white blood cell counts in children with acute leukemia, improving symptoms with no adverse events. Further studies are needed to confirm their impact on long-term outcomes.
Area of Science:
- Pediatric Oncology
- Hematology
Background:
- Pediatric oncology advances have reduced acute leukemia mortality.
- Hyperleukocytosis in acute leukemia increases risks of leukostasis and tumor lysis syndrome.
- Leukapheresis and exchange transfusion are potential interventions for high-risk patients.
Purpose of the Study:
- To evaluate the clinical outcome of pediatric acute leukemia patients with hyperleukocytosis who underwent leukapheresis or exchange transfusion.
Main Methods:
- Retrospective review of pediatric acute leukemia patients diagnosed between 1998-2008.
- Identified patients with hyperleukocytosis (WBC > 100 GPT/L) at diagnosis.
- Analyzed outcomes following leukapheresis or exchange transfusion.
Main Results:
- 11% (14/77) of pediatric acute leukemia patients presented with hyperleukocytosis.
- 4 patients received exchange transfusion, and 2 underwent leukapheresis.
- All patients achieved significant cytoreduction within 24 hours, with symptom improvement and no adverse events.
Conclusions:
- Leukapheresis and exchange transfusion, alongside conservative and oncologic therapies, facilitate rapid leukocyte reduction with acceptable risk.
- Further multicenter studies or registries are required to determine the precise impact on short- and long-term outcomes in pediatric acute leukemia.
Background:
The risk of severe complications or death during the initial period of acute leukemia was markedly decreased due to the progress in pediatric oncology and use of simple measures like hyperhydration, forced diuresis, treatment of hyperuricemia, correction of electrolyte and coagulation disturbances and the careful use of antileukemic drugs. The incidence of leukostasis and tumor lysis syndrome depends on absolute initial white blood cell counts and the underlying type of leukemia. Leukapheresis or exchange transfusion may improve the prognosis of high risk patients.
Methods:
Records of all pediatric patients who were newly diagnosed with acute leukemia between 1 / 1998 und 12 / 2008 were retrospectively reviewed for presence of hyperleukocytosis(white blood cell count > 100 GPT / l) at diagnosis and subsequent leukapheresis or exchange transfusion in regards to the clinical outcome.
Results:
At diagnosis 11 (14 % ) of 77 children with acute leukemia (7 acute lymphoblastic leukemia / ALL; 4 acute myeloblastic leukemia /AML) had hyperleukocytosis. 4 patients (2 ALL, 2 AML) received exchange transfusion and 2 others (1 ALL, 1 AML) underwent leukapheresis. Marked cytoreduction was achieved in all patients within 24 h after therapy initiation. There were no procedure-related adverse events. Symptoms due to hyperleukocytosis markedly improved after cytoreduction.
Conclusion:
Leukapheresis or exchange transfusion together with conservative management and specific oncological therapy may contribute to rapid leukocyte reduction with acceptable risk. The exact impact of leukapheresis or exchange transfusion on short and long term outcome in pediatric patients with acute leukemia and initial hyperleukocytosis has to be evaluated in future multicentre studies or by the formation of clinical registries.
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