1
|
Pourhassan H, Kareem W, Agrawal V, Aldoss I. Important Considerations in the Intensive Care Management of Acute Leukemias. J Intensive Care Med 2024; 39:291-305. [PMID: 37990559 DOI: 10.1177/08850666231193955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
In the realm of hematologic disorders, acute leukemia is approached as an emergent disease given the multitude of complications and challenges that present both as a result of inherent disease pathology and adverse events associated with antineoplastic therapies and interventions. The heavy burden of leukemic cells may lead to complications including tumor lysis syndrome, hyperleukocytosis, leukostasis, and differentiation syndrome, and the initiation of treatment can further exacerbate these effects. Capillary leak syndrome is observed as a result of antineoplastic agents used in acute leukemia, and L-asparaginase, a bacterial-derived enzyme, has a unique side effect profile including association with thrombosis. Thrombohemorrhagic syndrome and malignancy-associated thrombosis are also commonly observed complications due to direct disequilibrium in coagulant and anticoagulant factors. Due to inherent effects on the white blood cell milieu, leukemia patients are inherently immunocompromised and vulnerable to life-threatening sepsis. Lastly, the advents of newer therapies such as chimeric antigen receptor (CAR) T-cells have clinicians facing the management of related toxicities on unfamiliar territory. This review aims to discuss these acute leukemia-associated complications, their pathology, and management recommendations.
Collapse
Affiliation(s)
- Hoda Pourhassan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Waasil Kareem
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Vaibhav Agrawal
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| |
Collapse
|
2
|
Rozenbaum D, Lebold KM, Lee D, Salmi D, Htet NN. Cardiovascular collapse and McConnell's sign as early manifestations of leucostasis. BMJ Case Rep 2024; 17:e257330. [PMID: 38367997 PMCID: PMC10875556 DOI: 10.1136/bcr-2023-257330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
A man in his late 70s with chronic myelomonocytic leukaemia presented for evaluation of acute leukaemic transformation and initiation of cytoreductive therapy after being found to have asymptomatic hyperleucocytosis. Within 24 hours, the patient developed vasopressor-refractory shock, severe lactic acidosis and multiorgan failure. Serial echocardiographic assessments revealed interval enlargement of the right ventricle with development of the McConnell's sign, and abdominal CT showed diffuse bowel wall thickening, likely due to ischaemia. CT angiography excluded pulmonary embolism or occlusion of intra-abdominal arteries. Despite aggressive care, the patient died from cardiovascular collapse within 8 hours of the onset of hypotension. An autopsy revealed extensive infiltration of early myeloid cells in pulmonary, myocardial, hepatic and intestinal microvasculature. This case illustrates different mechanisms by which leucostasis causes acute cardiovascular collapse and stresses the emergent nature of this diagnosis.
Collapse
Affiliation(s)
- Daniel Rozenbaum
- Critical Care Medicine, Stanford Health Care, Stanford, California, USA
| | - Katie M Lebold
- Emergency Medicine, Stanford Health Care, Stanford, California, USA
| | - Dasom Lee
- Hematology Oncology, Stanford Health Care, Stanford, California, USA
| | - Darren Salmi
- Pathology and Surgery (Clinical Anatomy), Stanford Health Care, Stanford, California, USA
| | - Natalie N Htet
- Emergency Medicine, Stanford Health Care, Stanford, California, USA
| |
Collapse
|
3
|
Farid KMN, Sauer T, Schmitt M, Müller-Tidow C, Schmitt A. Symptomatic Patients with Hyperleukocytic FLT3-ITD Mutated Acute Myeloid Leukemia Might Benefit from Leukapheresis. Cancers (Basel) 2023; 16:58. [PMID: 38201486 PMCID: PMC10778499 DOI: 10.3390/cancers16010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE We aimed to identify subsets of patients who benefit from emergency LA and to establish a therapeutic algorithm for AML patients with hyperleukocytosis. METHODS In this single-center retrospective cohort study, a total of 20 consecutive patients underwent LA because of their clinical symptoms. Overall survival (OS) analysis was conducted using the Kaplan-Meier plot method. Univariate and multivariate analyses (using multiple logistic regression) were performed. At the time of diagnosis, all patients received a standard diagnostic workup for AML including FLT3-ITD mutational analysis. RESULTS FLT3-ITD mut AML patients receiving LA had a median OS of 437 days (range 5-2379 days) with a corresponding 14-day survival of 92.3%, while FLT3 wt AML patients displayed a significantly lower median OS of only 5 days (range 1-203 days) with a corresponding 14-day survival of 14.3% (p = 0.0001). CONCLUSIONS Among patients with clinical symptoms of leukostasis, the subset of FLT3-ITD mut AML patients showed a better outcome with lower early mortality after emergency LA. Based on these observations, we established a therapeutic algorithm for AML patients with hyperleukocytosis.
Collapse
Affiliation(s)
| | - Tim Sauer
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Michael Schmitt
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany
- German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Anita Schmitt
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany
| |
Collapse
|
4
|
Lee H, Han JH, Kim JK, Yoo J, Cho HS, Yoon JH, Cho BS, Kim HJ, Lim J, Jekarl DW, Kim Y. Effectiveness of leukapheresis on early survival in acute myeloid leukemia: An observational propensity score matching cohort study. J Clin Apher 2023; 38:727-737. [PMID: 37786990 DOI: 10.1002/jca.22090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The association between leukapheresis (LK) as a treatment option for hyperleukocytosis (HL) in patients with acute myeloid leukemia (AML) remains controversial. METHODS Data were extracted from the electronic medical record for 2801 patients with AML between April 2009 and December 2019. LK was performed when the leukocyte count was ≥100 × 109 /L at the time initial bone marrow examination. RESULTS A comparison between the patients with HL in the non-LK (n = 1579) and LK (n = 208) groups revealed survival probabilities (%) of 93.2% and 90.4% (P = .130) for day 30 (D30), 85.4% and 84.2% (P = .196) for D60, and 83.6% and 80.8% (P = .258) for D90, respectively. After propensity score matching, a comparison between the patients with HL in the non-LK (n = 192) and LK (n = 192) groups revealed survival probabilities (%) of 83.9% and 91.2% (P = .030) for D30, 75.0% and 84.9% (P = .015) for day 60 (D60), and 62.4% and 81.3% (P = .034) for day 90 (D90), respectively. After D150, the observed effect of LK appeared to be mitigated without a survival benefit. DISCUSSION LK was associated with improved early survival outcomes at D30, D60, and D90 among patients with AML exhibiting HL. Thus, it may be considered a treatment option for reducing cell mass in such patients.
Collapse
Affiliation(s)
- Howon Lee
- Department of Laboratory Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jay Ho Han
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Kwon Kim
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaeeun Yoo
- Department of Laboratory Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Suk Cho
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Laboratory Medicine, Apheresis Unit, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Ho Yoon
- Division of Hematology, Department of Internal Medicine, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung Sik Cho
- Division of Hematology, Department of Internal Medicine, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- Division of Hematology, Department of Internal Medicine, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jihyang Lim
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Wook Jekarl
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Laboratory Medicine, Apheresis Unit, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Research and Development Institute for In Vitro Diagnostic Medical Devices, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yonggoo Kim
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
5
|
Ai J. Take a spin: Apheresis in the care of adult leukaemia patients. Best Pract Res Clin Haematol 2023; 36:101467. [PMID: 37353291 DOI: 10.1016/j.beha.2023.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 06/25/2023]
Abstract
Apheresis is an automated process to separate the whole blood of a patient or a donor, collect or remove specific blood components, and return the remaining back to the individual. Apheresis is an integral part of blood and marrow transplantation and has been increasingly utilized in novel cellular therapies for a variety of blood disorders. This review uses clinical cases to highlight the multiple roles of apheresis in the care of adult leukaemia patients, including therapeutic leukapheresis in hyperleukocytosis, mobilized peripheral blood hematopoietic progenitor cell collection in donors, mononucleated cell collection in preparation of donor lymphocyte infusion or chimeric antigen receptor T cells manufacture, and extracorporeal photopheresis in the treatment of graft versus host diseases.
Collapse
Affiliation(s)
- Jing Ai
- Transplant and Cellular Therapy Program, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, LCI 2, Charlotte, NC, 28204, USA.
| |
Collapse
|
6
|
De la Garza-Salazar F, Gómez-De León A, Gómez-Almaguer D, Colunga-Pedraza PR. Vinblastine as a bridge to 7 + 3 in acute myeloid leukaemia. Ann Hematol 2023; 102:487-489. [PMID: 36651981 DOI: 10.1007/s00277-022-05048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Fernando De la Garza-Salazar
- Hematology Service, Hospital Universitario "Dr, José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario "Dr, José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - David Gómez-Almaguer
- Hematology Service, Hospital Universitario "Dr, José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico
| | - Perla R Colunga-Pedraza
- Hematology Service, Hospital Universitario "Dr, José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero and Avenida Gonzalitos, Mitras Centro, Z.P. 64460, Monterrey, NL, Mexico.
| |
Collapse
|
7
|
Lopert P, Abdelrahman S, Graybill CA, Rhodes J, Dierickx D, Schäfer R, Reti M, Wu D, Hu Y, Huang F, Hu J, He P, Liu L, Li M, Zhang X, Bill J. Safety and performance of the Spectra Optia apheresis system for white blood cell depletion in patients with elevated white blood cell counts. J Clin Apher 2023. [PMID: 36655281 DOI: 10.1002/jca.22038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND For the past 30 years, white blood cell depletion (WBCD) or leukocytapheresis has been conducted to rapidly reduce excessive circulating white blood cell (WBC) concentrations in patients at risk for or with symptoms of leukostasis due to hyperleukocytosis. The goal of leukocytapheresis is to prevent or treat acute complications from leukostasis, thereby enabling patients to receive potentially curative chemotherapy. METHODS This report details the results from a retrospective and a prospective clinical study conducted in the European Union and the People's Republic of China, which assessed the use of the Spectra Optia Apheresis System for leukocytapheresis in patients with hyperleukocytosis. The primary objective of both studies was to the assess the safety and performance of the WBCD procedure in patients with elevated WBC counts. RESULTS Data were collected from 72 participants completing 87 WBCD procedures. The mean percent change in participant WBC counts post-procedure was 50.3 ± 21.2% and the collection efficiency (CE1) of the WBCD procedures was 53.7 ± 19.8%. Sixty-one participants (95.3%) experienced a total of 279 adverse events (AEs) with the majority of the AEs related to post-procedure changes in laboratory values, which is an anticipated AE in this patient population. CONCLUSION The data collected within these studies indicate that the WBCD procedure is safe and well tolerated in patients with hyperleukocytosis as evaluated by percent decrease in WBC count, CE1, and AE incidence.
Collapse
Affiliation(s)
| | | | | | | | | | - Richard Schäfer
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Frankfurt, Germany
| | - Marienn Reti
- Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Szent Laszla Hospital Campus, Budapest, Hungary
| | - Depei Wu
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Hu
- Wuhan Union Hospital, Wuhan, China
| | | | - Jianda Hu
- Fujian Medical University Union Hospital, Fujian, China
| | - Pengcheng He
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ligen Liu
- Tongren Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ming Li
- The Second People's Hospital of Shenzhen, Shenzhen, China
| | - Xuejun Zhang
- The Second Hospital of Hebei Medical University, Xi'an, China
| | - Jerry Bill
- Terumo BCT, Inc., Lakewood, Colorado, USA
| |
Collapse
|
8
|
Macaron W, Sargsyan Z, Short NJ. Hyperleukocytosis and leukostasis in acute and chronic leukemias. Leuk Lymphoma 2022; 63:1780-1791. [DOI: 10.1080/10428194.2022.2056178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Walid Macaron
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zaven Sargsyan
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nicholas J. Short
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
9
|
Zhang X, Tu Y, Shen J, Feng Y, Ma H, Bai L, Li X, Lin Z, Dai L, Gong F, Lu T, Zhou J, Chen H, Lv Q, Zhu Z, Ruan C. Effectiveness and safety of leukapheresis in hyperleukocytic leukemias: a retrospective multicenter study. Leuk Lymphoma 2022; 63:2636-2644. [PMID: 35731036 DOI: 10.1080/10428194.2022.2086246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Leukapheresis is an effective adjuvant therapy for leukemia patients with hyperleukocytosis, but few studies have reported recent data with modern modalities and comparisons among different leukemia types. We conducted a retrospective study on leukapheresis among 420 patients with AML, ALL and CML in four local centers. WBC counts decreased significantly (p < 0.001) postleukapheresis in all three cohorts. Clearance efficiency was higher in acute leukemia patients than CML patients (p < 0.01). Concomitant leukocytoreduction drugs improved WBC reduction only in AML patients (p < 0.05). Leukocyte, hemoglobin and platelet levels preleukapheresis might affect the clearance efficiency in AML and/or ALL patients. Hematological toxicities were the major concerns, but most of them were mild, and only 11 patients died of all causes within one week postleukapheresis. In conclusion, leukapheresis can safely reduce the leukemic burden, especially for patients with acute leukemias.
Collapse
Affiliation(s)
- Xiang Zhang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Stem Cells and Biomedical, Materials of Jiangsu Province and Chinese Ministry of Science and Technology, Suzhou, China
| | - Yuqing Tu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Stem Cells and Biomedical, Materials of Jiangsu Province and Chinese Ministry of Science and Technology, Suzhou, China
| | - Juan Shen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Yufeng Feng
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Houshi Ma
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Lian Bai
- Department of Hematology, Suzhou Canglang Hospital, Suzhou, China
| | - Xiaoli Li
- Department of Hematology, Suzhou Hongci Blood Disease Hospital, Suzhou, China
| | - Zhihong Lin
- Department of Hematology, Suzhou Yongding Hospital, Suzhou, China
| | - Lijun Dai
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feiran Gong
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tianyu Lu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Hematology, Suzhou Hongci Blood Disease Hospital, Suzhou, China
| | - Jiazi Zhou
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hanqing Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Hematology, Suzhou Hongci Blood Disease Hospital, Suzhou, China
| | - Quansheng Lv
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ziling Zhu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Changgeng Ruan
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Stem Cells and Biomedical, Materials of Jiangsu Province and Chinese Ministry of Science and Technology, Suzhou, China
| |
Collapse
|
10
|
Hamadi R, Assaad M, Zurndorfer J, El Gharib K, Kwok R, Dhar M, Schwab A. Intraparenchymal Hemorrhage: A Fatal Presentation of Undiagnosed Acute Myelogenous Leukemia. Cureus 2022; 14:e25592. [PMID: 35795513 PMCID: PMC9250100 DOI: 10.7759/cureus.25592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/05/2022] Open
|
11
|
Jones SR, Rahrig A, Saraf AJ. Leukapheresis in Pediatric Acute Leukemia with Hyperleukocytosis: A Single-Center Experience. CHILDREN 2022; 9:children9040503. [PMID: 35455547 PMCID: PMC9024808 DOI: 10.3390/children9040503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/21/2022]
Abstract
Hyperleukocytosis in pediatric acute leukemia is associated with increased morbidity and mortality and at present there is no consensus on the use of leukapheresis (LPH) for its management. Our aim was to review characteristics and outcomes of newly diagnosed leukemia patients with hyperleukocytosis (HL) comparing those who received LPH and those who did not. An IRB approved retrospective case control study reviewed data from a single institution over a 10 year period. At our institution, LPH was used in 8 of 62 (13%) patients with hyperleukocytosis with minimal complications. Mean leukocyte count in patients who received LPH versus those who did not was 498 k cells/mm3 and 237 k cells/mm3, respectively. Patients who had symptoms of neurologic (63 vs. 17%) or pulmonary leukostasis (75 vs. 17%) were more likely to have undergone leukapheresis. The time from presentation to the initiation of chemotherapy was not different between those who received LPH and those who did not (mean of 35 h vs. 34 h). There was one death in the LPH group, that was the result of neurologic sequelae of hyperleukocytosis and not LPH itself. The use of LPH in patients with hyperleukocytosis is safe, well tolerated and does not alter time to chemotherapy at our institution.
Collapse
Affiliation(s)
- Sandra Renee Jones
- Department of Internal Medicine, University of Miami and Jackson Memorial Hospital Internal Medicine Residency Program, Miami, FL 33136, USA;
| | - April Rahrig
- Division of Pediatric Hematology & Oncology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Amanda J. Saraf
- Division of Pediatric Hematology & Oncology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
- Correspondence:
| |
Collapse
|
12
|
Takahashi T, Turcotte LM, Gordon PM, Johnson AD, Rubin N, Spector LG. Therapeutic Leukapheresis in Pediatric Leukemia: Utilization Trend and Early Outcomes in a US Nationwide Cohort. J Pediatr Hematol Oncol 2022; 44:47-53. [PMID: 33735152 PMCID: PMC8568727 DOI: 10.1097/mph.0000000000002140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
Leukapheresis (LA) in pediatric leukemia is performed for leukostasis, a life-threatening emergency in the setting of extremely increased blast cell counts. The authors aimed to assess the epidemiology of pediatric leukemia who received LA. The authors reviewed US nationally representative admission records of patients less than 20 years of age in the Kids' Inpatient Database for the years 2000, 2003, 2006, 2009, 2012, and 2016. Incidence of new leukemia cases who underwent LA were calculated for the years 2009, 2012, and 2016. Cox and logistic regression analyses were performed to ascertain the risk factors for adverse outcomes. There were 526 admissions for pediatric patients with acute lymphoblastic leukemia (ALL) (n=328), acute myeloid leukemia (AML) (n=124), or chronic myeloid leukemia (CML) (n=74) who underwent LA over the study period. The incidence of leukemia cases that required LA was lower in 2016 than in 2009 or 2012 (1.4%, 2.2%, and 2.7%, respectively; P=0.001). In-hospital mortality was higher in AML than ALL (hzard ratio, 3.2; 95% confidence interval, 1.1-9.1). None with CML died during admission. This first population-based study of LA in pediatric leukemia showed a decreased utilization of LA over recent years. The higher inpatient mortality in AML, as compared with ALL or CML, warrant further investigations.
Collapse
MESH Headings
- Child
- Humans
- Leukapheresis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/therapy
- Leukostasis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Retrospective Studies
Collapse
Affiliation(s)
- Takuto Takahashi
- Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Lucie M. Turcotte
- Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Peter M. Gordon
- Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | - Andrew D. Johnson
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Nathan Rubin
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Logan G. Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| |
Collapse
|
13
|
Rinaldi I, Sutandyo N, Winston K. Comparison of early mortality between leukapheresis and non-leukapheresis in adult acute myeloid leukemia patients with hyperleukocytosis: a systematic review and meta-analysis. Hematology 2022; 27:141-149. [DOI: 10.1080/16078454.2021.2024939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Noorwati Sutandyo
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Dharmais National Cancer Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kevin Winston
- Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
14
|
Bontinis A, Bontinis V, Koutsoumpelis A, Vasileios P, Georgia K, Giannopoulos A, Ktenidis K. Acute leukemia presenting as acute lower limb ischemia. VASA 2021; 51:37-45. [PMID: 34794339 DOI: 10.1024/0301-1526/a000977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives: Acute lower limb ischemia (ALLI) is a common vascular emergency. However, ALLI presenting as the initial symptom of acute leukemia (AL) is scarce. Here we present a case of ALLI in the setting of acute myeloid leukemia (AML) while systematically reviewing the current literature to withdraw conclusions about the management, prognosis, and treatment for this atypical presentation of AL. Methods: We conducted a systematic electronic research according to Preferred Reporting Items for Systematic Review and Meta-Analysis protocol (PRISMA) for articles published from January 1981 up to January 2021 concerning ALLI in the setting of acute leukemia (AL). Patients' baseline characteristics were recorded and nine outcomes of interest were studied. Results: Twenty-six individuals, 16 males with a mean age of 46.3 years (±20) were included in this review. The diagnosis included 13 AML patients (50%), 11 acute promyelotic leukemia (APL) (42.3%) and two acute lymphoblastic leukemias (ALL) (7.7%). Treatment varied among nine different regimens. Four patients were treated with chemotherapy alone (15.4%), four with thrombectomy alone (15.4%), and 11 with a combination of chemotherapy and thrombectomy (42.3%). Eight major amputations were recorded (30. 8%). Thirty-day mortality was 35.7%. Forty-eight peripheral thrombotic events were recorded with 12 patients suffering recurrent thrombotic events. Conclusion: ALLI as the presenting symptom of AL is a rare condition that carries significant mortality and amputation rates. Timely diagnosis is crucial concerning short-term survival and limb salvage. APL, despite being the rarest form of AL, represented a significant proportion of the patient population in this review. The role of leukostasis in the disease's progression and the efficacy of leukapheresis as a treatment regimen should be further investigated through case-control studies.
Collapse
Affiliation(s)
- Alkis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Vangelis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Perifanis Vasileios
- First Propaedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Kaiafa Georgia
- First Propaedeutic Department of Internal Medicine, Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Argirios Giannopoulos
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Kiriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| |
Collapse
|
15
|
Ağrali Eröz N, Derviş MF, Tuna Deveci R, Sencer S, Peker B, Demirkol D. Intracranial Hemorrhage Associated With T-Cell Acute Lymphoblastic Leukemia With Hyperleukocytosis: A Case Report. J Pediatr Hematol Oncol 2021; 43:e812-e815. [PMID: 33797454 DOI: 10.1097/mph.0000000000002027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022]
Abstract
Acute leukemia in children may present with hyperleukocytosis. Symptomatic hyperleukocytosis is a medical emergency that necessitates rapid stabilization of the patient and prompt lowering of the leukocyte count. We report on a patient with intracranial hemorrhage associated with T-cell acute lymphoblastic leukemia with hyperleukocytosis, which is a rare occurrence. A 16-year-old boy with hyperleukocytosis (total white cell count; 398×103/µL) underwent repeated leukapheresis and received supportive treatment until a definite diagnosis of T-cell acute lymphoblastic leukemia was made and chemotherapy was started at 10% of the usual dose. On day 2 of treatment, he had headache, vomiting, and was agitated. Brain magnetic resonance imaging showed bilateral extensive hemispheric and cerebellar punctate areas of hemorrhage and perilesional edema. Chemotherapy intensified to a maximum dose on day 3. If supportive care for tumor lysis syndrome can be promptly provided, initial chemotherapy regimen can immediately be begun at an optimal dose.
Collapse
Affiliation(s)
| | | | | | | | | | - Demet Demirkol
- Departments of Pediatric Intensive Care
- Child Health Institute, Istanbul University, Istanbul, Turkey
| |
Collapse
|
16
|
Zhang D, Zhu Y, Jin Y, Kaweme NM, Dong Y. Leukapheresis and Hyperleukocytosis, Past and Future. Int J Gen Med 2021; 14:3457-3467. [PMID: 34285568 PMCID: PMC8286901 DOI: 10.2147/ijgm.s321787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/05/2021] [Indexed: 01/04/2023] Open
Abstract
Hyperleukocytosis is a hematologic crisis caused by excessive proliferation of leukemic cells and has a relatively high early mortality due to a series of severe complications. Therefore, prompt and effective intervention is required. Leukapheresis performed using apheresis equipment to separate leukocytes from peripheral blood, at the same time returns autologous plasma, platelets and erythrocytes to the patient, is applied clinically for the treatment of hyperleukocytosis. Leukapheresis not only removes excessive leukocytes rapidly and corrects metabolic abnormalities but also alleviates the symptoms of leukostasis. In addition, the procedure of leukapheresis is generally well tolerated. Leukapheresis has become one of the most imperative adjuvant therapies to treat hyperleukocytosis, especially in the patient who was not inappropriate to cytoreduce with Ara-C or hydroxyurea. In this review, we present the background of leukapheresis development and highlight its clinical application in hyperleukocytic leukemia patients.
Collapse
Affiliation(s)
- Dongdong Zhang
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, 441000, People's Republic of China
| | - Yufan Zhu
- Orthopedics department, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Yanxia Jin
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Natasha Mupeta Kaweme
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Youhong Dong
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, 441000, People's Republic of China
| |
Collapse
|
17
|
Rinaldi I, Sari RM, Tedhy VU, Winston K. Leukapheresis Does Not Improve Early Survival Outcome of Acute Myeloid Leukemia with Leukostasis Patients - A Dual-Center Retrospective Cohort Study. J Blood Med 2021; 12:623-633. [PMID: 34290537 PMCID: PMC8286962 DOI: 10.2147/jbm.s312140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/30/2021] [Indexed: 01/12/2023] Open
Abstract
Introduction Leukostasis is a medical emergency with high mortality which often occurs in acute myeloid leukemia patients with hyperleukocytosis. One of the therapies that can be used for leukostasis in acute myeloid leukemia is leukapheresis. However, whether leukapheresis can provide better survival benefit when compared with patients not receiving leukapheresis is still unclear. Hence, we aimed to evaluate the effect of chemotherapy plus leukapheresis combination versus chemotherapy only on 28-day survival of acute myeloid leukemia patients with leukostasis. Methods This study was a dual-center retrospective cohort using secondary data from medical records collected from November 2018 to March 2019. Inclusion criteria were adult patients aged 18 years old or above, diagnosed with acute leukemia with hyperleukocytosis status defined by WBC count greater than 100,000/uL, and with symptoms of leukostasis. One-month survival analysis was conducted using Kaplan–Meier curve method. Univariate and multivariate analyses were then conducted using Cox proportional hazards model to obtain value of hazard ratio (HR) with a 95% confidence interval (CI). Results A total of 38 patients were obtained for analysis. The median overall survival was 25 days (95% CI: 17.001–32.999 days) in the chemotherapy only group and 20 days (95% CI: 1.497–38.503) in the chemotherapy with leukapheresis group. The use of leukapheresis did not affect 28-day survival (HR: 1.140; 95% CI: 0.396–3.283; p value: 0.809) and 7-day survival (HR: 1.073; 95% CI: 0.277–4.152; p value: 0.919). In the multivariate analysis, age ≥60 years, blast percentage ≥90%, creatinine ≥1.4 mg/dL, and presence of disseminated intravascular coagulation were associated with worse 28-day survival. Conclusion AML patients with leukostasis who received both chemotherapy and leukapheresis did not have better 28-day survival and 7-day survival when compared with patients receiving chemotherapy only. Old age, high blast percentage, high creatinine, and presence of disseminated intravascular coagulation were prognostic factors for worse 28-day survival.
Collapse
Affiliation(s)
- Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Resti Mulya Sari
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Dharmais National Cancer Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Kevin Winston
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
18
|
Tu YQ, Fan Y, Zhu ZL, Chen J, Song TM, Zhang X, Lu Y, Wu DP. [Efficacy and safety of leukapheresis for hyperleukocytic leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:161-164. [PMID: 33858049 PMCID: PMC8071669 DOI: 10.3760/cma.j.issn.0253-2727.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Y Q Tu
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Y Fan
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Z L Zhu
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - J Chen
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - T M Song
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - X Zhang
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Y Lu
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - D P Wu
- National Clinical Research Center for Hematologic Diseases, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| |
Collapse
|
19
|
Göçer M, Kurtoğlu E. Effect of prophylactic leukapheresis on early mortality and overall survival in acute leukemia patients with hyperleukocytosis. Ther Apher Dial 2021; 25:697-703. [PMID: 33686785 DOI: 10.1111/1744-9987.13645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
Hyperleukocytosis has been associated with early mortality owing to the presence of complications including leukostasis, tumor lysis syndrome (TLS), and disseminated intravascular coagulation (DIC). Leukapheresis is a fast and effective cytoreductive procedure that removes leukocytes from the peripheral circulation. This single-center, retrospective, and observational study included 32 patients diagnosed with acute leukemia who underwent leukapheresis due to hyperleukocytosis between 2014 and 2020. This study primarily aimed to investigate the effect of prophylactic leukapheresis on early mortality and overall survival (OS). In the symptomatic group, seven and two patients died in the first and second weeks, respectively. In the prophylactic leukapheresis group, two and one patients died in the first and second weeks (p = 0.792), respectively. OS was significantly longer in the prophylactic leukapheresis group (p = 0.004). The leukapheresis procedure appears to be effective on early mortality and OS. Initiation of prophylactic leukapheresis before the appearance of leukostasis symptoms is effective on OS and possibly early mortality.
Collapse
Affiliation(s)
- Mesut Göçer
- Department of Internal Medicine, Division of Hematology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Erdal Kurtoğlu
- Department of Internal Medicine, Division of Hematology, Antalya Training and Research Hospital, Antalya, Turkey
| |
Collapse
|
20
|
The factors influencing clinical outcomes after leukapheresis in acute leukaemia. Sci Rep 2021; 11:6426. [PMID: 33742034 PMCID: PMC7979875 DOI: 10.1038/s41598-021-85918-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/08/2021] [Indexed: 12/01/2022] Open
Abstract
Leukapheresis is used for the mechanical removal of leukaemic cells in hyperleukocytosis. However, the effectiveness of leukapheresis remains unclear due to selection and confounding factors in the cohorts. We compared the effectiveness of leukapheresis among the subgroups according to either the 2016 World Health Organization classification or the number of cytogenetic abnormalities with a retrospective, single-centre study from January 2009 to December 2018. Acute myeloid leukaemia (AML, n = 212) and acute lymphoblastic leukaemia (ALL, n = 97) were included. The 30-day survival rates (95% confidence interval, 95% CI) for AML and ALL were 86.3% (81.6–90.9%) and 94.8% (90.3–99.2%), respectively. For AML, ‘primary AML with myelodysplasia-related changes’ and ‘AML with biallelic mutation of CEBPA’ showed better 30-day survival outcomes (P = 0.026) than the other subgroups. A higher platelet count after leukapheresis was associated with better 30-day survival in AML patients (P = 0.029). A decrease in blast percentage count after leukapheresis was associated with better 30-day survival in ALL patients (P = 0.034). Our study suggested that prophylactic platelet transfusion to raise the platelet count to 50 × 109/L or greater might improve clinical outcome in AML patients undergoing leukapheresis.
Collapse
|
21
|
Connelly-Smith L, Linenberger ML. Leukocytapheresis for AML hyperleukocytosis: Failing to make the grade. Transfusion 2021; 60:2161-2163. [PMID: 33615498 DOI: 10.1111/trf.16091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Laura Connelly-Smith
- Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - Michael L Linenberger
- Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| |
Collapse
|
22
|
Bewersdorf JP, Giri S, Tallman MS, Zeidan AM, Stahl M. Leukapheresis for the management of hyperleukocytosis in acute myeloid leukemia—A systematic review and meta‐analysis. Transfusion 2020; 60:2360-2369. [DOI: 10.1111/trf.15994] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Jan P. Bewersdorf
- Department of Internal Medicine, Section of Hematology Yale School of Medicine New Haven Connecticut USA
| | - Smith Giri
- Division of Hematology and Oncology University of Alabama School of Medicine Birmingham Alabama USA
| | - Martin S. Tallman
- Leukemia Service Memorial Sloan Kettering Cancer Center New York New York USA
| | - Amer M. Zeidan
- Department of Internal Medicine, Section of Hematology Yale School of Medicine New Haven Connecticut USA
| | - Maximilian Stahl
- Leukemia Service Memorial Sloan Kettering Cancer Center New York New York USA
| |
Collapse
|
23
|
Shallis RM, Stahl M, Bewersdorf JP, Hendrickson JE, Zeidan AM. Leukocytapheresis for patients with acute myeloid leukemia presenting with hyperleukocytosis and leukostasis: a contemporary appraisal of outcomes and benefits. Expert Rev Hematol 2020; 13:489-499. [PMID: 32248712 DOI: 10.1080/17474086.2020.1751609] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Hyperleukocytosis, defined as a total white blood cell count (WBC) >50 or more commonly >100 × 109 cells/L, is a presenting feature of acute myeloid leukemia (AML) in about 6-20% of cases and is associated with a higher risk of tumor lysis syndrome (TLS), disseminated intravascular coagulation (DIC), clinical leukostasis with end organ damage, and mortality.Areas covered: In this review, authors discuss the implications of hyperleukocytosis in AML and the current understanding of cytoreductive strategies with a focus on the use of leukocytapheresis.Expert commentary: Efforts to rapidly reduce peripheral myeloblasts have included the use of leukocytapheresis. Early studies demonstrated feasibility in reducing peripheral WBC and blast counts as well as clinically relevant patient outcomes which prompted its common use for many years. However, more recent data have directly challenged the previously touted reports of reduced TLS and DIC incidence as well as survival benefit, even in patients with clinical leukostasis. The use of leukocytapheresis remains highly controversial with wide practice variations among physicians, institutions, and countries given the lack of high-quality data, risks associated with leukocytapheresis itself, associated high costs, resource utilization, and lack of evidence-based clinical guidelines.
Collapse
Affiliation(s)
- Rory M Shallis
- Division of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Maximilian Stahl
- Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jan Philipp Bewersdorf
- Division of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jeanne E Hendrickson
- Departments of Laboratory Medicine and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Amer M Zeidan
- Division of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| |
Collapse
|
24
|
Management of hyperleukocytosis and impact of leukapheresis among patients with acute myeloid leukemia (AML) on short- and long-term clinical outcomes: a large, retrospective, multicenter, international study. Leukemia 2020; 34:3149-3160. [PMID: 32132655 PMCID: PMC8155811 DOI: 10.1038/s41375-020-0783-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 01/20/2023]
Abstract
Hyperleukocytosis in acute myeloid leukemia (AML) is associated with inferior outcomes. There is limited high quality evidence to support the benefits of leukapheresis. We retrospectively collected data from patients with newly-diagnosed AML who presented with a white cell count (WBC) >50×109/L to 12 centers in the United States and Europe from 2006–2017 and received intensive chemotherapy. Logistic regression models estimated odds ratios for 30-day mortality and achievement of composite complete remission (CRc). Cox proportional hazard models estimated hazard ratios for overall survival (OS). Among 779 patients, clinical leukostasis was reported in 27%, and leukapheresis was used in 113 patients (15%). Thirty-day mortality was 16.7% (95%CI:13.9–19.3%). Median OS was 12.6 months (95%CI:11.5–14.9) among all patients, and 4.5 months (95%CI: 2.7–7.1) among those ≥65 years. Use of leukapheresis did not significantly impact 30-day mortality, achievement of CRc, or OS in multivariate analysis based on available data or in analysis based on multiple imputation. Among patients with investigator-adjudicated clinical leukostasis, there were statistically significant improvements in 30-day mortality and OS with leukapheresis in unadjusted analysis, but not in multivariate analysis. Given the significant resource use, cost, and potential complications of leukapheresis, randomized studies are needed to evaluate its value.
Collapse
|
25
|
Implementation of a Multidisciplinary Care Pathway via an Emergency Department-ICU to Improve Care of Emergency Department Patients Presenting With Leukostasis. Crit Care Explor 2020; 2:e0084. [PMID: 32211616 PMCID: PMC7069592 DOI: 10.1097/cce.0000000000000084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Leukostasis is a life-threatening complication of acute hyperleukocytic leukemia, and is associated with substantial mortality. Management of leukostasis requires time-sensitive diagnostics and therapeutics, and leukapheresis remains a mainstay of treatment in select patients. Leukapheresis requires coordination of multi-disciplinary resources, which can prove challenging in the emergency department setting, and delays in treatment due to the complexity and coordination required are common. The objective of this study was to assess the effect of utilization of an emergency department-ICU and a multidisciplinary care pathway on outcomes of critically ill leukostasis patients presenting to the emergency department.
Collapse
|
26
|
Worel N, Mansouri Taleghani B, Strasser E. Recommendations for Therapeutic Apheresis by the Section "Preparative and Therapeutic Hemapheresis" of the German Society for Transfusion Medicine and Immunohematology. Transfus Med Hemother 2020; 46:394-406. [PMID: 31933569 DOI: 10.1159/000503937] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/07/2019] [Indexed: 01/18/2023] Open
Abstract
The section "Preparative and Therapeutic Hemapheresis" of the German Society for Transfusion Medicine and Immunohematology (DGTI) has reviewed the actual literature and updated techniques and indications for evidence-based use of therapeutic apheresis in human disease. The recommendations are mostly in line with the "Guidelines on the Use of Therapeutic Apheresis in Clinical Practice" published by the Writing Committee of the American Society for Apheresis (ASFA) and have been conducted by experts from the DACH (Germany, Austria, Switzerland) region.
Collapse
Affiliation(s)
- Nina Worel
- Department for Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, Austria
| | - Behrouz Mansouri Taleghani
- University Clinic of Hematology and Central Hematology Laboratory, Division of Transfusion Medicine, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Erwin Strasser
- Department of Transfusion Medicine and Hemostasis, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
27
|
Al Haj Moussa A, Maaz AUR, Faqih N, Sundaram M. Critically Ill Pediatric Oncology Patients: What the Intensivist Needs to Know? Pediatric Critical Care Medicine. Indian J Crit Care Med 2020; 24:1256-1263. [PMID: 33446982 PMCID: PMC7775926 DOI: 10.5005/jp-journals-10071-23693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Cancer is an evolving cause of morbidity and mortality in children worldwide. In recent decades, there has been a significant increase in the survival of children with cancer, after applying new methods and treatment protocols in practice. However, the complexity of the disease itself, as well as the intensity and toxicity of treatment is such that many children require admission to the pediatric intensive care unit (PICU) which should be well equipped and led by personnel who have adequate training and expertise to provide optimum care to these complex patients. Most oncology patients who require PICU admission categorized into oncological emergencies, and/or decompensation from treatment and its side effects. In this study, we provide a summary of the essential and most recent evidence-based recommendations from published reviews and articles to aid PICU physicians and to ensure the best treatment and outcome possible for the children with such disease. How to cite this article: Al Haj Moussa A, Maaz AUR, Faqih N, Sundaram M. Critically Ill Pediatric Oncology Patients: What the Intensivist Needs to Know? Pediatric Critical Care Medicine. Indian J Crit Care Med 2020;24(12):1256-1263.
Collapse
|
28
|
Nguyen TH, Bach KQ, Vu HQ, Nguyen NQ, Duong TD, De Reys S, Wheeler J. Pre‐chemotherapy white blood cell depletion by therapeutic leukocytapheresis in leukemia patients: A single‐institution experience. J Clin Apher 2019; 35:117-124. [DOI: 10.1002/jca.21766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/03/2019] [Accepted: 11/20/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Thanh H. Nguyen
- National Institute of Hematology and Blood Transfusion Hanoi Vietnam
| | - Khanh Q. Bach
- National Institute of Hematology and Blood Transfusion Hanoi Vietnam
| | - Hung Q. Vu
- National Institute of Hematology and Blood Transfusion Hanoi Vietnam
| | - Nhat Q. Nguyen
- National Institute of Hematology and Blood Transfusion Hanoi Vietnam
| | - Thien D. Duong
- National Institute of Hematology and Blood Transfusion Hanoi Vietnam
| | | | | |
Collapse
|
29
|
Reid JH, Perissinotti AJ, Benitez L, Bixby DL, Burke P, Pettit K, Marini BL. Impact of prophylactic intrathecal chemotherapy on CNS relapse rates in AML patients presenting with hyperleukocytosis. Leuk Lymphoma 2019; 61:862-868. [PMID: 31739707 DOI: 10.1080/10428194.2019.1691199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Central nervous system (CNS) relapse in acute myeloid leukemia (AML) confers a poor prognosis. Despite the identification of risk factors for CNS relapse (e.g. hyperleukocytosis), there is no standard practice for CNS relapse risk reduction with intrathecal (IT) chemotherapy in patients. We compared outcomes of 50 patients who did not receive IT chemotherapy with 18 patients who did receive IT chemotherapy with a hyperleukocytosis at diagnosis (defined as white blood cell count ≥100,000 cells/mcL). There were three occurrences of CNS relapse, all within patients who did not receive prophylaxis. There was no difference in the incidence of CNS relapse between the patient cohorts (p = .560). These results highlight the low incidence of CNS relapse in our patient population that received and survived induction chemotherapy despite selecting for a high risk cohort. Furthermore, there is a need for a CNS relapse registry to standardize treatment approaches in this high-risk patient population.
Collapse
Affiliation(s)
- Justin H Reid
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI, USA.,University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Anthony J Perissinotti
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI, USA.,University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Lydia Benitez
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI, USA.,University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Dale L Bixby
- Department of Internal Medicine and Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Patrick Burke
- Department of Internal Medicine and Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kristen Pettit
- Department of Internal Medicine and Division of Hematology and Oncology, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Bernard L Marini
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, MI, USA.,University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| |
Collapse
|
30
|
Cohn CS, Allen ES, Cushing MM, Dunbar NM, Friedman DF, Goel R, Harm SK, Heddle N, Hopkins CK, Klapper E, Perumbeti A, Ramsey G, Raval JS, Schwartz J, Shaz BH, Spinella PC, Pagano MB. Critical developments of 2018: A review of the literature from selected topics in transfusion. A committee report from the AABB's Clinical Transfusion Medicine Committee. Transfusion 2019; 59:2733-2748. [PMID: 31148175 DOI: 10.1111/trf.15348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The AABB compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine. An abridged version of this work is being made available in TRANSFUSION, with the full-length report available as Appendix S1 (available as supporting information in the online version of this paper). STUDY DESIGN AND METHODS Papers published in late 2017 and 2018 are included, as well as earlier papers cited for background. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are covered: "big data" and "omics" studies, emerging infections and testing, platelet transfusion and pathogen reduction, transfusion therapy and coagulation, transfusion approach to hemorrhagic shock and mass casualties, therapeutic apheresis, and chimeric antigen receptor T-cell therapy. CONCLUSION This synopsis may be a useful educational tool.
Collapse
Affiliation(s)
- Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth S Allen
- Department of Pathology, University of California, San Diego, California
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - David F Friedman
- Blood Bank and Transfusion Medicine Department, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ruchika Goel
- Division of Transfusion Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Hematology/Oncology, Mississippi Valley Regional Blood Center, Springfield, Illinois
| | - Sarak K Harm
- University of Vermont Medical Center, Burlington, VT
| | - Nancy Heddle
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | | | - Ellen Klapper
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ajay Perumbeti
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Glenn Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University, and, New York, New York
| | | | - Philip C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care, Washington University in St Louis School of Medicine, Saint Louis, Missouri
| | - Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
31
|
|
32
|
Abstract
Emergency providers are likely to encounter patients with acute and chronic leukemias. In some cases, the first presentation to the emergency department may be for symptoms related to blast crisis and leukostasis. Making a timely diagnosis and consulting a hematologist can be life saving. Presenting symptoms are caused by complications of bone marrow infiltration and hyperleukocytosis with white blood cell counts over 100,000. Presentations may include fatigue (anemia), bleeding (thrombocytopenia), shortness of breath, and/or neurologic symptoms owing to hyperleukocytosis and subsequent leukostasis. Treatment of symptomatic cases involves induction chemotherapy and/or leukapheresis. Asymptomatic hyperleukocytosis can be treated with hydroxyurea.
Collapse
Affiliation(s)
- Geremiha Emerson
- Department of Emergency Medicine, Wexner Medical Center at The Ohio State University, 760 Prior Hall, 376 West 10th Avenue, Columbus, OH 43210, USA.
| | - Colin G Kaide
- Department of Emergency Medicine, Wexner Medical Center at The Ohio State University, 760 Prior Hall, 376 West 10th Avenue, Columbus, OH 43210, USA
| |
Collapse
|
33
|
Stahl M, Pine A, Hendrickson JE, Litzow MR, Luger SM, Stone RM, Erba HP, Kim TK, Sekeres MA, Steensma DP, Komrokji RS, Gore SD, Zeidan AM. Beliefs and practice patterns in hyperleukocytosis management in acute myeloid leukemia: a large U.S. web-based survey .. Leuk Lymphoma 2018; 59:2723-2726. [PMID: 29667455 DOI: 10.1080/10428194.2018.1452219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | | | | | - Selina M Luger
- d Abramson Cancer Center at the University of Pennsylvania School of Medicine , Paoli , PA , USA
| | | | - Harry P Erba
- f UAB Comprehensive Cancer Center, Hematologic Malignancy Program , University of Alabama at Birmingham , Birmingham , AL , USA
| | | | - Mikkael A Sekeres
- g Leukemia Program, Department of Hematologic Oncology and Blood Disorders , Cleveland Clinic Taussig Cancer Institute , Cleveland , OH , USA
| | | | - Rami S Komrokji
- h Malignant Hematology Department , H. Lee Moffitt Cancer Center , Tampa , FL , USA
| | | | | |
Collapse
|
34
|
Van de Louw A, Desai RJ, Zhu J, Claxton DF. Characteristics of early acute respiratory distress syndrome in newly diagnosed acute myeloid leukemia. Leuk Lymphoma 2018; 59:2369-2376. [PMID: 29431568 DOI: 10.1080/10428194.2018.1435874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Acute respiratory complications occur frequently during the early phase of acute myeloid leukemia (AML) but information on the most severe form, acute respiratory distress syndrome (ARDS), is lacking. We retrospectively analyzed 280 patients with newly diagnosed AML in order to describe the incidence, risk factors and early mortality associated with ARDS within 15 d. Univariate and then multivariate analysis were performed. ARDS developed in 9% of patients and was associated with 64% day-30 mortality. White blood cell count on admission was an independent risk factor for ARDS (OR = 1.007, 95% CI = 1.001-1.012, p = .012) with a moderate prediction ability (AUC 0.704, p = .001). Other variables were associated with ARDS in univariate but not in multivariate analysis: body mass index (p = .06), transfusions (p = .001) and sepsis (p < .0001). Leukemia-specific complications and documented infections were the most frequent ARDS etiologies and were sometimes associated, with no clear distinctive temporal pattern.
Collapse
Affiliation(s)
- Andry Van de Louw
- a Division of Pulmonary and Critical Care Medicine , Penn State Milton S Hershey Medical Center and College of Medicine , Hershey , PA , USA
| | - Ruchi J Desai
- b Department of Internal Medicine , Penn State Milton S Hershey Medical Center and College of Medicine , Hershey , PA , USA
| | - Junjia Zhu
- c Department of Public Health Sciences , Penn State Milton S Hershey Medical Center and College of Medicine , Hershey , PA , USA
| | - David F Claxton
- d Division of Hematology and Oncology , Penn State Milton S Hershey Medical Center and College of Medicine , Hershey , PA , USA
| |
Collapse
|
35
|
Korkmaz S. The management of hyperleukocytosis in 2017: Do we still need leukapheresis? Transfus Apher Sci 2018; 57:4-7. [DOI: 10.1016/j.transci.2018.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
36
|
Jin Y, Guo S, Cui Q, Chen S, Liu X, Wei Y, Pan Y, Tang L, Huang T, Shen H, Xu G, Zuo X, Liu S, Xiao H, Chen F, Gong F, Zhou F. A hospital based retrospective study of factors influencing therapeutic leukapheresis in patients presenting with hyperleukocytic leukaemia. Sci Rep 2018; 8:294. [PMID: 29321527 PMCID: PMC5762875 DOI: 10.1038/s41598-017-17534-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/20/2017] [Indexed: 02/04/2023] Open
Abstract
Therapeutic leukapheresis is a rapid and effective method to reduce early mortality of patients with hyperleukocytic leukaemia (HLL). However, few studies on factors influencing the efficiency have been reported. In this study, 67 cases who underwent leukapheresis were retrospectively analysed and factors related to the collection efficiency of leukapheresis (CEWBC) were also evaluated. Paired t test showed that there was a significant decrease in statistics of white blood cell (WBC) counts after apheresis. The results of two independent samples nonparametric test suggested that WBC counts, platelet (PLT) counts, haematocrit (HCT), hemoglobin (HGB), serum chlorine (Cl) and globulin (GLB) before leukapheresis correlated with the CEWBC. Multiple linear regression analysis with background stepwise variable selection indicated that only WBC and HCT before leukapheresis had an influence on CEWBC significantly. Kaplan-Meier analysis and Cox regression model indicated that lymphocyte (LY) and mean corpuscular hemoglobin (MCH) pre-apheresis as independent factors significantly affected the prognostic survival of patients with HLL. Moreover, platelets and red blood cell were contaminated in the product of leukapheresis. It is an urgent problem to be solved in order to realise higher efficacy and higher purity of WBC collection to improve the survival of patients with HLL through optimising instruments.
Collapse
Affiliation(s)
- Yanxia Jin
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shishang Guo
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, Hubei, China
| | - Qin Cui
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Sichao Chen
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaoping Liu
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yongchang Wei
- Key Laboratory of Tumor Biological Behavior of Hubei Province, Wuhan, Hubei, China.,Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yunbao Pan
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Liang Tang
- School of Mechanical Engineering, Hubei University of Technology, Wuhan, Hubei, China
| | - Tingting Huang
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hui Shen
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Guanghui Xu
- School of Mechanical Engineering, Hubei University of Technology, Wuhan, Hubei, China
| | - Xuelan Zuo
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shangqin Liu
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hui Xiao
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Fei Chen
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Fayun Gong
- School of Mechanical Engineering, Hubei University of Technology, Wuhan, Hubei, China.
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China. .,Key Laboratory of Tumor Biological Behavior of Hubei Province, Wuhan, Hubei, China. .,Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
| |
Collapse
|
37
|
Malkan UY, Ozcebe OI. Leukapheresis do not improve early death rates in acute myeloid leukemia patients with hyperleukocytosis. Transfus Apher Sci 2017; 56:880-882. [DOI: 10.1016/j.transci.2017.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/23/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
|
38
|
Zeng F, Huang H, Fu D, Huang Q, Fan L, Wei S. Leukapheresis in 15 patients weighing 20kg or less: A single centre experience. Transfus Apher Sci 2017; 56:889-893. [PMID: 29169683 DOI: 10.1016/j.transci.2017.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/14/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
The application of apheresis equipment to perform leukapheresis (LK) in low weight paediatric patients is logistically complex and lacking of largest clinical performing experiences, meanwhile, the benefit from LK is controversial. In this study, 15 children with acute lymphoblastic leukemia(ALL)and acute myeloid leukemia (AML) and hyperleukocytosis were treated with the COBE Spectra apheresis system in the general paediatric ward by the staff from the department of Blood Transfusion. 26 LK procedures were performed. 12 patients (80%) were performed with peripheral veins, others (20%) with femoral veins. Median age, body weight of the patients was 4 years (range from1year 10 month to 7 years) and 15kg (range from10 to 20kg). The median white blood cell (WBC) count of pre-first-LK was 289×109/L (range from 108×109/L to 579×109/L). The median decrease in WBC count after each LK was 34% (range from 14% to 54%), and overall decrease in WBC after completion of LK procedures was 45% (range from 15% to 70%). All of the patients had no further signs of leukostasis and achieved marked reductions in WBC counts. Only minor clinical adverse events were attributable to LK. With adequate monitoring and experienced team, LK is a safe and may be a beneficial leukoreduction method in small patients weighing 20kg or less with ALL and AML.
Collapse
Affiliation(s)
- Feng Zeng
- Department of Blood Transfusion, Fujian Medical University Union Hospital, Fuzhou, China
| | - HaoBo Huang
- Department of Blood Transfusion, Fujian Medical University Union Hospital, Fuzhou, China.
| | - DanHui Fu
- Department of Blood Transfusion, Fujian Medical University Union Hospital, Fuzhou, China; Department of Haematology, Fujian Medical University Union Hospital, Fujian Institute of Haematology, Fuzhou, China.
| | - QingHua Huang
- Department of Blood Transfusion, Fujian Medical University Union Hospital, Fuzhou, China
| | - LiPing Fan
- Department of Blood Transfusion, Fujian Medical University Union Hospital, Fuzhou, China
| | - ShiJing Wei
- Department of Blood Transfusion, Fujian Medical University Union Hospital, Fuzhou, China
| |
Collapse
|
39
|
Tendulkar AA, Jain PA, Gupta A, Sharma N, Navkudkar A, Patle V. Therapeutic leukocyte reduction for acute and chronic myeloid leukemias: A 4-year experience from an oncology center in India. Asian J Transfus Sci 2017; 11:156-161. [PMID: 28970685 PMCID: PMC5613424 DOI: 10.4103/ajts.ajts_103_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hyperleukocytosis (HL) and leukostasis seen in myeloid leukemias are a medical emergency. We present a case series of ten such patients in a 4-year period. Sixteen therapeutic leukocyte reduction (TLR) were done in ten cases along with other supportive measures. The American Society for Apheresis supports the routine implementation of TLR in cases of HL secondary to myeloid leukemias with signs of leukostasis. MATERIALS AND METHODS The procedures were performed on the intermittent flow cell separator after discussion with the treating physician about patient's condition. Clinical, demographic, analytical, and technical variables were reviewed retrospectively and the patients were followed up at the end of 4 years. Descriptive analysis was performed for all variables, and relationships between quantitative variables and categorical variables were determined by applying the Student's t-test. RESULTS The mean age of presentation was 34 years. Priapism was the most common symptom followed by respiratory distress and neurological disturbances. After an average of 1.6 TLR procedures, the mean leukocyte count reduction achieved was 39.9% along with symptomatic relief. The mean survival at 4-year follow-up was 12.8 months and the overall mortality was 20%. Acute myeloid leukemia patients presented with lower mean platelet counts compared to chronic myeloid leukemia patients; however, the platelet loss in the final product was minimized. CONCLUSION TLR is a safe and effective therapy for leukoreduction in hematological malignancies in our experience.
Collapse
Affiliation(s)
- Anita A Tendulkar
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Puneet A Jain
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhaykumar Gupta
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nidhi Sharma
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anisha Navkudkar
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vijaya Patle
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
40
|
Choi MH, Choe YH, Park Y, Nah H, Kim S, Jeong SH, Kim HO. The effect of therapeutic leukapheresis on early complications and outcomes in patients with acute leukemia and hyperleukocytosis: a propensity score-matched study. Transfusion 2017; 58:208-216. [DOI: 10.1111/trf.14329] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Min Hyuk Choi
- Departments of Laboratory Medicine; Yonsei University College of Medicine; Seoul Korea
- Department of Laboratory Medicine; National Health Insurance Service Ilsan Hospital; Goyang Korea
| | - Yeon Hwa Choe
- Internal Medicine; Yonsei University College of Medicine; Seoul Korea
| | - Yongjung Park
- Department of Laboratory Medicine; National Health Insurance Service Ilsan Hospital; Goyang Korea
| | - Hyunjin Nah
- Departments of Laboratory Medicine; Yonsei University College of Medicine; Seoul Korea
| | - Sinyoung Kim
- Departments of Laboratory Medicine; Yonsei University College of Medicine; Seoul Korea
| | - Seok Hoon Jeong
- Departments of Laboratory Medicine; Yonsei University College of Medicine; Seoul Korea
| | - Hyun Ok Kim
- Departments of Laboratory Medicine; Yonsei University College of Medicine; Seoul Korea
| |
Collapse
|
41
|
Cline A, Jajosky R, Shikle J, Bollag R. Comparing leukapheresis protocols for an AML patient with symptomatic leukostasis. J Clin Apher 2017; 33:396-400. [PMID: 28940295 DOI: 10.1002/jca.21588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/01/2017] [Accepted: 09/09/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a malignancy characterized by rapid clonal proliferation of myeloid precursors, which can result in hyperleukocytosis. Leukapheresis can be used to rapidly reduce the white blood cell count (WBC). However, the only FDA cleared device for WBC depletion, the COBE Spectra, will no longer be supported by the manufacturer in 2017, and there are few studies comparing different methods of leukapheresis. CASE REPORT A 68-year-old African American female was admitted to the hospital for relapse of her AML. Laboratory data demonstrated a WBC count of 291 600/μL and flow cytometry of the peripheral blood demonstrated 85% myeloid blasts. Leukapheresis was ordered to help treat the leukostasis. METHODS Three different apheresis protocols were used to achieve cytoreduction: Spectra Optia mononuclear collection (MNC) protocol, Spectra Optia granulocyte collection (PMN) protocol, and Therakos CELLEX buffy coat collection without return. Due to different inlet flow rates, the procedures were evaluated based on the number of WBCs collected and volume of blood processed (VBP). RESULTS The Spectra Optia PMN collected the most WBCs and collected nearly as many WBCs per VBP as the Therakos CELLEX, which had the highest value. CONCLUSION To our knowledge, we are reporting the first use of Therakos CELLEX and Spectra Optia PMN protocol for WBC depletion. While the Spectra Optia granulocyte protocol showed the best performance for this AML patient, further studies will be needed to compare the Spectra Optia PMN protocol to the MNC protocol for AML patients.
Collapse
Affiliation(s)
- Abigail Cline
- Medical College of Georgia, Augusta University Medical Center, Augusta, Georgia
| | - Ryan Jajosky
- Medical College of Georgia, Augusta University Medical Center, Augusta, Georgia
| | - James Shikle
- Medical College of Georgia, Augusta University Medical Center, Augusta, Georgia
| | - Roni Bollag
- Medical College of Georgia, Augusta University Medical Center, Augusta, Georgia
| |
Collapse
|
42
|
Zeller B, Glosli H, Forestier E, Ha SY, Jahnukainen K, Jónsson ÓG, Lausen B, Palle J, Hasle H, Abrahamsson J. Hyperleucocytosis in paediatric acute myeloid leukaemia - the challenge of white blood cell counts above 200 × 109
/l. The NOPHO experience 1984-2014. Br J Haematol 2017; 178:448-456. [DOI: 10.1111/bjh.14692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/02/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Bernward Zeller
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
| | - Heidi Glosli
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
| | - Erik Forestier
- Department of Medical Biosciences, Genetics; Umeå University Hospital; Umeå Sweden
| | - Shau-Yin Ha
- Department of Paediatrics and Adolescent Medicine; Queen Mary Hospital and Hong Kong Paediatric Haematology & Oncology Study Group (HKPHOSG); Hong Kong China
| | - Kirsi Jahnukainen
- Children's Hospital; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Ólafur G. Jónsson
- Department of Paediatrics; Landspitali University Hospital; Reykjavík Iceland
| | - Birgitte Lausen
- Department of Paediatrics and Adolescent Medicine; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Josefine Palle
- Department of Woman′s and Children′s Health; Uppsala University; Uppsala Sweden
| | - Henrik Hasle
- Department of Paediatrics; Aarhus University Hospital Skejby; Aarhus Denmark
| | - Jonas Abrahamsson
- Department of Paediatrics; Institution for Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | | |
Collapse
|
43
|
Pulmonary Leukostasis: Treatment When Cytoreduction Does Not Suffice. J Pediatr Hematol Oncol 2017; 39:156-158. [PMID: 28060107 DOI: 10.1097/mph.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Nan X, Qin Q, Gentille C, Ensor J, Leveque C, Pingali SR, Phan AT, Rice L, Iyer S. Leukapheresis reduces 4-week mortality in acute myeloid leukemia patients with hyperleukocytosis – a retrospective study from a tertiary center. Leuk Lymphoma 2017; 58:1-11. [DOI: 10.1080/10428194.2016.1277386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Xinyu Nan
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Qian Qin
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Cesar Gentille
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Joe Ensor
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA
| | - Christopher Leveque
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Sai R. Pingali
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA
| | - Alexandria T. Phan
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA
| | - Lawrence Rice
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Swaminathan Iyer
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
45
|
Van de Louw A. Effect of leukapheresis on blood coagulation in patients with hyperleukocytic acute myeloid leukemia. Transfus Apher Sci 2016; 56:214-219. [PMID: 28041822 DOI: 10.1016/j.transci.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/08/2016] [Accepted: 12/08/2016] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Leukapheresis has been proposed to reduce white blood cell (WBC) count in hyperleukocytic acute myeloid leukemia (AML). However, no survival benefit has been proven and leukapheresis can potentially affect coagulation and worsen bleeding and disseminated intravascular coagulation (DIC). We analyzed the effect of leukapheresis on coagulation tests in a cohort of hyperleukocytic AML patients. METHODS Retrospective chart review of hyperleukocytic AML patients who underwent leukapheresis between 2003 and 2014. Blood coagulation tests (platelets, PT, INR, aPTT, fibrinogen, D-Dimers and fibrin degradation products (FDP)) were collected before and after each procedure and DIC score was computed. Transfusions of platelets and coagulation factors were collected. RESULTS Ninety patients and 129 leukapheresis sessions were screened. After exclusion of the sessions associated with transfusions, we observed in 44 patients a significant decrease in platelets (from 75.69±89.48 to 44.59±47.71.109/L, p=0.001) and fibrinogen (from 4.05±1.29 to 3.35±1.37g/L, p<0.0005) along with an increase in PT (from 14.62±2.73 to 15.62±3.63s, p=0.001), aPTT (from 33.70±6.32 to 39.24±13.53s, p=0.009) and INR (from 1.33±0.2 to 1.45±0.34, p=0.002) after the first procedure. Bleeding complications, all intracerebral hemorrhages, were documented in 3 patients within 24h of leukapheresis. After combining 73 repeat procedures, we observed similar significant results except for the aPTT prolongation. The platelets and PT components of the DIC score, but not the fibrinogen component, were significantly increased after leukapheresis. CONCLUSIONS In hyperleukocytic AML patients, leukapheresis is associated with clinically significant decreases in platelets and fibrinogen and prolonged clotting times.
Collapse
Affiliation(s)
- Andry Van de Louw
- Division of Pulmonary and Critical Care Medicine, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA.
| |
Collapse
|
46
|
Giammarco S, Chiusolo P, Piccirillo N, Di Giovanni A, Metafuni E, Laurenti L, Sica S, Pagano L. Hyperleukocytosis and leukostasis: management of a medical emergency. Expert Rev Hematol 2016; 10:147-154. [DOI: 10.1080/17474086.2017.1270754] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Sabrina Giammarco
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Chiusolo
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Piccirillo
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Alessia Di Giovanni
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Metafuni
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Laurenti
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Sica
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Livio Pagano
- Department of Hematology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
47
|
Stefanski M, Jamis-Dow C, Bayerl M, Desai RJ, Claxton DF, Van de Louw A. Chest radiographic and CT findings in hyperleukocytic acute myeloid leukemia: A retrospective cohort study of 73 patients. Medicine (Baltimore) 2016; 95:e5285. [PMID: 27858899 PMCID: PMC5591147 DOI: 10.1097/md.0000000000005285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hyperleukocytic acute myeloid leukemia (AML) is associated with pulmonary complications and high early mortality rate, but given its rarity, data on chest radiographic presentation are scarce.We retrospectively reviewed the charts of 73 AML patients admitted with white blood cell count >100 × 10/L between 2003 and 2014 in order to describe the chest radiographic and computed tomography (CT) findings and to correlate them with AML subtype and respiratory symptoms.Forty-two of the 73 patients (58%) overall and 36 of the 54 patients (67%) with clinical signs of pulmonary leukostasis had abnormal radiographs on admission. The presence of radiographic abnormalities was significantly associated with dyspnea and oxygen/ventilatory support requirements (P < 0.01) and with day 28 mortality (45% vs 13%, P = 0.005) but not with monocytic subtype of AML. Sixteen patients had isolated focal basilar airspace opacities, unilateral (n = 13) or bilateral (n = 3), while 16 patients had bilateral diffuse opacities, interstitial (n = 12) or airspace and interstitial (n = 4). Two patients had isolated pleural effusion, 2 patients had unilateral midlung airspace opacities, and 6 patients had a combination of focal airspace and diffuse interstitial opacities. Overall, 2 patterns accounted for 75% of abnormal findings: bilateral diffuse opacities tended to be associated with monocytic AML, whereas basilar focal airspace opacities were more frequent in nonmonocytic AML (P < 0.05). Eighteen patients had CT scans, revealing interlobular septal thickening (n = 12), airspace (n = 11) and ground-glass (n = 9) opacities, pleural effusions (n = 12), and acute pulmonary embolism (n = 2).Hyperleukocytic AML is frequently associated with abnormal chest radiographs, involving mostly focal basilar airspace opacities (more frequent in nonmonocytic AML) or diffuse bilateral opacities. CT scan should be considered broadly due to the suboptimal resolution of radiographs for detecting signs of leukostasis.
Collapse
Affiliation(s)
| | | | | | | | - David F. Claxton
- Division of Hematology and Oncology, Penn State Milton S. Hershey Medical Center and College of Medicine, Hershey, PA
| | - Andry Van de Louw
- Division of Pulmonary and Critical Care Medicine
- Correspondence: Andry Van de Louw, Division of Pulmonary and Critical Care Medicine, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033 (e-mail: )
| |
Collapse
|
48
|
Villgran V, Agha M, Raptis A, Hou JZ, Farah R, Lim SH, Redner RL, Im A, Sehgal A, Dorritie KA, Kiss JE, Normolle D, Boyiadzis M. Leukapheresis in patients newly diagnosed with acute myeloid leukemia. Transfus Apher Sci 2016; 55:216-220. [DOI: 10.1016/j.transci.2016.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
|
49
|
Creutzig U, Rössig C, Dworzak M, Stary J, von Stackelberg A, Wössmann W, Zimmermann M, Reinhardt D. Exchange Transfusion and Leukapheresis in Pediatric Patients with AML With High Risk of Early Death by Bleeding and Leukostasis. Pediatr Blood Cancer 2016; 63:640-5. [PMID: 26670831 DOI: 10.1002/pbc.25855] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/21/2015] [Accepted: 11/04/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The risk of early death (ED) by bleeding/leukostasis is high in patients with AML with hyperleukocytosis (>100,000/μl). Within the pediatric AML-BFM (Berlin-Frankfurt-Münster) 98/04 studies, emergency strategies for these children included exchange transfusion (ET) or leukapheresis (LPh). Risk factors for ED and interventions performed were analyzed. PATIENTS Two hundred thirty-eight of 1,251 (19%) patients with AML presented with hyperleukocytosis; 23 of 1,251 (1.8%) patients died of bleeding/leukostasis. RESULTS ED due to bleeding/leukostasis was highest at white blood cell (WBC) count >200,000/μl (14.3%). ED rates were even higher (20%) in patients with FAB (French-American-British) M4/M5 and hyperleukocytosis >200,000/μl. Patients with WBC >200,000/μl did slightly better with ET/LPh compared to those without ET/LPh (ED rate 7.5% vs. 21.2%, P = 0.055). Multivariate WBC >200,000/μl was of strongest prognostic significance for ED (P(χ(2) ) <0.0001). CONCLUSION Our data confirm the high risk of bleeding/leukostasis in patients with hyperleukocytosis. ET/LPh shows a trend toward reduced ED rate due to bleeding/leukostasis and is recommended at WBC >200,000/μl, and in FAB M4/M5 even at lower WBC.
Collapse
Affiliation(s)
- Ursula Creutzig
- Department of Pediatric Hematology and Oncology Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Claudia Rössig
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Michael Dworzak
- Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Arend von Stackelberg
- Department of Pediatric Oncology/Hematology, Charité University Medical Center Berlin, Berlin, Germany
| | - Wilhelm Wössmann
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany
| | - Martin Zimmermann
- Department of Pediatric Hematology and Oncology Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Dirk Reinhardt
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
50
|
Fesnak A, Lin C, Siegel DL, Maus MV. CAR-T Cell Therapies From the Transfusion Medicine Perspective. Transfus Med Rev 2016; 30:139-45. [PMID: 27067907 DOI: 10.1016/j.tmrv.2016.03.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/21/2016] [Indexed: 02/06/2023]
Abstract
The use of chimeric antigen receptor (CAR)-T cell therapy for the treatment of hematologic malignancies has generated significant excitement over the last several years. From a transfusion medicine perspective, the implementation of CAR-T therapy as a potential mainstay treatment for not only hematologic but also solid-organ malignancies represents a significant opportunity for growth and expansion. In this review, we will describe the rationale for the development of genetically redirected T cells as a cancer therapeutic, the different elements that are required to engineer these cells, as well as an overview of the process by which patient cells are harvested and processed to create and subsequently validate CAR-T cells. Finally, we will briefly describe some of the toxicities and clinical efficacy of CAR-T cells in the setting of patients with advanced malignancy.
Collapse
Affiliation(s)
- Andrew Fesnak
- Division of Transfusion Medicine & Therapeutic Pathology, Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - ChieYu Lin
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Don L Siegel
- Division of Transfusion Medicine & Therapeutic Pathology, Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Marcela V Maus
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA.
| |
Collapse
|