Leukostasis in Chronic Lymphocytic Leukemia.

Area of Science:

• Hematology
• Oncology

Background:

• Chronic lymphocytic leukemia (CLL) is a slow-growing B-cell neoplasm where not all patients require immediate treatment.
• Hyperleukocytosis, defined as a white blood cell count >100×10⁹/L, is common in CLL.
• Symptomatic hyperleukocytosis, or leukostasis, is an extremely rare presentation of CLL.

Observation:

• Leukostasis occurs due to leukemic cell aggregation, impairing tissue perfusion and causing respiratory, neurological, or renal symptoms.
• A case report details a 77-year-old woman with untreated CLL presenting with respiratory distress and hyperleukocytosis (WBC 524×10⁹/L).
• This patient required intubation, chemotherapy with chlorambucil, and two leukapheresis sessions for management.

Findings:

• The patient with CLL-associated leukostasis showed a good response to chlorambucil and leukapheresis.
• This case highlights successful management in a patient with a WBC count of 524×10⁹/L, lower than typically reported in leukostasis literature (>1000×10⁹/L).

Implications:

• Leukostasis is a critical medical emergency in CLL patients with hyperleukocytosis and acute symptoms, necessitating ICU admission.
• Early diagnosis and intervention, including hydration, tumor lysis syndrome management, cytoreduction, and leukapheresis, are vital.
• Awareness of this rare complication is essential for clinicians to prevent increased morbidity and mortality in CLL patients.