Comparing leukapheresis protocols for an AML patient with symptomatic leukostasis

Area of Science:

• Hematology
• Medical Devices
• Oncology

Background:

• Acute myeloid leukemia (AML) can cause hyperleukocytosis, necessitating rapid white blood cell (WBC) reduction.
• The sole FDA-cleared device for WBC depletion, COBE Spectra, is being discontinued, highlighting the need for alternative methods.
• Limited research exists comparing different leukapheresis techniques for managing hyperleukocytosis in AML.

Observation:

• A patient with relapsed AML presented with a WBC count of 291,600/μL and 85% myeloid blasts.
• Leukapheresis was initiated to address leukostasis, a complication of hyperleukocytosis.
• Three apheresis protocols were evaluated: Spectra Optia MNC, Spectra Optia PMN, and Therakos CELLEX buffy coat collection.

Findings:

• The Spectra Optia PMN protocol demonstrated the highest WBC collection efficiency.
• The Therakos CELLEX protocol showed the highest WBCs collected per volume of blood processed (VBP).
• The Spectra Optia PMN protocol collected nearly as many WBCs per VBP as the Therakos CELLEX.

Implications:

• This study reports the first use of Therakos CELLEX and Spectra Optia PMN for WBC depletion in AML.
• The Spectra Optia granulocyte protocol appears effective for WBC reduction in AML patients with hyperleukocytosis.
• Further research is required to compare the Spectra Optia PMN protocol against the MNC protocol for AML treatment.