Frequency of early death in children with acute leukemia presenting with hyperleukocytosis

The relationship of hyperleukocytosis, early death, and intracerebral hemmorahage was determined in 547 pediatric patients with acute leukemia. Hyperleukocytosis occurred in 7.3% of patients with acute leukemia. The early mortality rate was significantly increased in hyperleukocytic patients when compared to the nonhyperleukocytic group. Hyperleukocytic patients with ANLL had a significantly greater risk of early death than nonhyperleukocytic patients with ANLL. The difference in the incidence of early death between hyperleukocytic and nonhyperleukocytic patients with ALL/AUL was not statistically significant. In the hyperleukocytic patients intracerebral hemorrhage was the universal cause of early death but this entity did not occur in any of the nonhyperleukocytic patients. There was no correlation of intracerebral hemorrhage to thrombocytopenia or coagulation abnormalities. Autopsies confirmed intracerebral hemorrhage and leukostasis with leukemic infiltration of the brain tissue.