1
|
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
|
2
|
Zhang D, Lin H, Huang L. Repeated small-volume exchange transfusion for hyperleukocytosis in pediatric acute leukemia: A retrospective analysis. Front Pediatr 2023; 11:1155481. [PMID: 37033185 PMCID: PMC10073680 DOI: 10.3389/fped.2023.1155481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Leukapheresis reduces hyperleukocytosis in children with acute leukemia. Although the usefulness of this procedure is under debate, a repeated small-volume exchange transfusion along with leukapheresis yielded satisfactory results. Methods Forty-seven patients with acute leukemia [32 acute lymphocytic leukemia (ALL) and 15 acute myeloblastic leukemia (AML)] were enrolled between January 2017 and June 2022 and underwent repeated small-volume exchange transfusion. The following were measured: demographic and clinical characteristics, time of the procedure, PWBC (peripheral white blood cell) count, hemoglobin, platelet count, blood biochemistry, electrolytes, coagulation, leukostasis, TLS (tumor lysis syndrome), DIC (disseminated intravascular coagulopathy), adverse events (AEs), and serious AEs (SAEs). Results The demographic and clinical characteristics were not significantly different between ALL and AML patients, but differences were observed in PWBC counts (424.2 ± 135.6 vs. 223.8 ± 58.0 × 109/L). The procedures needed 3-8 processes, and the average procedure time was not significantly different between ALL and AML. The PWBC count gradually reduced to <100 × 109/L; hemoglobin, platelet count, K+, Na+, and Ca2+ were unchanged. Alanine aminotransferase, aspartate aminotransferase, total bilirubin, blood urea nitrogen, creatinine, troponin-I, creatine kinase-MB, prothrombin time, and activated partial thromboplastin time maintained normal or recovered from abnormal ranges. The manifestations of leukostasis, TLS, and DIC improved or disappeared. No AEs and SAEs occurred. The required total blood volume was based on initial PWBC count, manifestations of leukostasis, and age. Conclusions Our finding suggests that repeated small-volume exchange transfusion is effective and safe for treating hyperleukocytosis in children with acute leukemia.
Collapse
Affiliation(s)
- Dongxiu Zhang
- Department of Pediatrics, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hailong Lin
- Department of Pediatrics, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Leting Huang
- Department of Hematology and Oncology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
- Correspondence: Leting Huang
| |
Collapse
|
3
|
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
|
4
|
Sherwen O, Baron MK, Murray NS, Heaton PA, Gamble J, Paul SP. The recognition and nursing management of common oncological emergencies in children. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:20-27. [PMID: 35019748 DOI: 10.12968/bjon.2022.31.1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An oncological emergency may be the initial presentation of a cancer, a sign of cancer progression, or a complication of cancer treatment. The most frequently encountered paediatric oncological emergencies include neutropenic sepsis, hyperleukocytosis, brain tumours presenting with raised intracranial pressure, tumour lysis syndrome and superior mediastinal syndrome. These are all life-threatening conditions that require urgent recognition and management. Health professionals working in an emergency department (ED) are likely to be involved in managing these children. This article brings together the current guidance and recommendations for these specific emergencies. It also includes two case studies that demonstrate the challenges health professionals can face while managing these situations. It is important that health professionals have an acute awareness of oncological emergencies. Confidence in recognising the presentations, diagnoses and initial management are essential because these conditions may be life-threatening and time critical.
Collapse
Affiliation(s)
| | | | | | | | - Jane Gamble
- Matron, Paediatrics, Yeovil District Hospital
| | | |
Collapse
|
5
|
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
|
6
|
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
|
7
|
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
|
8
|
Coffe C, Pouthier F, Barisien C, Slimane M, Sheytanova A. Therapeutic leukapheresis and thrombapheresis in medical emergencies. Transfus Apher Sci 2020; 59:102997. [PMID: 33189569 DOI: 10.1016/j.transci.2020.102997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The management of hyperleukocytosis or thrombocytosis by therapeutic cytapheresis in the early 21 st century is far from codified (universal). Therapeutic cytapheresis have been proposed to achieve more rapid cytoreduction in peripheral blood than old universal support in order to quickly prevent potential complications. But, there are no randomized studies demonstrating the superiority of cytapheresis over other treatments alone. In this short review, based on our own experience (since 1980), we will give the indications and the role of cytapheresis procedures and we will try to answer the questions: when is therapeutic cytapheresis appropriate and do they still have a place in 2020, especially as a medical emergency?
Collapse
Affiliation(s)
| | - Fabienne Pouthier
- Department of Cellular and Tissue Engineering, Etablissement Français du sang Bourgogne, Franche Comté, Besançon, France
| | - Christophe Barisien
- Department of Blood Donations, Etablissement Français du sang Bourgogne, Franche Comté, Besançon, France
| | - Mohamed Slimane
- Etablissement Français du sang Bourgogne, Franche Comté, Dijon, France
| | - Antoaneta Sheytanova
- Department of Therapeutic Apheresis, Etablissement Français du sang Bourgogne, Franche Comté, Besançon, France
| |
Collapse
|
9
|
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
|
10
|
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
|
11
|
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
|
12
|
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
|
13
|
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
|
14
|
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
|
15
|
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]
|
16
|
Abstract
PURPOSE OF REVIEW Over the past decades, survival of critically ill hematological patients has dramatically improved, and these patients are more frequently referred to the ICU for intensive treatment, including a rising need for administering anticancer-therapy in this setting. RECENT FINDINGS The scarce literature on this subject provides evidence for feasibility of administering chemotherapy in the ICU, with expected ICU survival of 60-70%, and one in three patients surviving at least 1 year after discharge. We summarize the recent evidence concerning outcome, dosing and indications of chemotherapy in the ICU, and provide practical guidelines for some special oncological situations. SUMMARY Anticancer-therapy in the ICU is feasible and no longer futile as long as it is initiated in a selected, well-informed patient population with reasonable prognostic expectations. Accurate recognition of organ failure and early referral to the ICU for both supportive care and timely administration of chemotherapy is recommended before the development of multisystem organ failure.
Collapse
|
17
|
Wang ML, Davenport RD, Yamada C. Comparison of two leukocytapheresis protocols in a case of idiopathic hypereosinophilic syndrome. J Clin Apher 2015; 31:481-9. [PMID: 26463664 DOI: 10.1002/jca.21435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/08/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hypereosinophilic syndrome (HEOS) is rare, and the efficacy of leukocytapheresis in this context is unclear. We here report the successful treatment of a patient with idiopathic HEOS with four leukocytapheresis procedures using two protocols. CASE A 4-year-old female presented with cardiac and respiratory dysfunction, and WBC of 225 K/μL with 96% eosinophils. Leukocytapheresis was started after initiation of methylprednisolone and hydroxyurea. She received two leukocytapheresis with polymorphonuclear cell (PMN) protocol, followed by initiation of imatinib therapy, then two leukocytapheresis with mononuclear cell (MNC) protocol. After the fourth leukocytapheresis, her WBC decreased to 69 K/μL with 82% eosinophils. She was discharged on hospital day 21 under stable condition with WBC of 22 K/μL with 86% eosinophils. WBC count and eosinophil percentage continued to decrease, and were 6.4 K/μL and 52% by 2 weeks and 3.9 K/μL and 4.9% by 3 months after discharge, respectively. FINDINGS WBC and absolute eosinophil (aEO) counts decreased by an average of 29.0 and 30.4% per leukocytapheresis, respectively. Normalized to estimated blood volume, procedures with PMN and MNC protocols changed, on average, WBC by -10.7 and -12.1%, aEO by -10.4 and -13.4%, platelet by -8.1 and -19.2%, and fluid balance by -129 and -47 mL, respectively. CONCLUSION Leukocytapheresis was effective in decreasing WBC and aEO counts in HEOS, with PMN and MNC protocols achieving similar reductions. However, PMN protocol resulted in greater negative fluid balance and MNC protocol resulted in greater platelet loss. J. Clin. Apheresis 31:481-489, 2016. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Michael L Wang
- Department of Pathology, Division of Transfusion Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Robertson D Davenport
- Department of Pathology, Division of Transfusion Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Chisa Yamada
- Department of Pathology, Division of Transfusion Medicine, University of Michigan Health System, Ann Arbor, Michigan.
| |
Collapse
|
18
|
Berber I, Kuku I, Erkurt MA, Kaya E, Gozukara Bag H, Nizam I, Koroglu M, Ozgul M, Bazna S. Leukapheresis in acute myeloid leukemia patients with hyperleukocytosis: A single center experience. Transfus Apher Sci 2015; 53:185-90. [DOI: 10.1016/j.transci.2015.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/02/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
|
19
|
Kwan L, Linden J, Gaffney K, Greene M, Vauthrin M, Ramanathan M, Weinstein R. Therapeutic leukocytapheresis for improvement in respiratory function in a woman with hyperleukocytosis and mantle cell lymphoma with a circulating small lymphocyte phenotype. J Clin Apher 2015; 31:398-402. [PMID: 26332581 DOI: 10.1002/jca.21411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/25/2015] [Indexed: 11/10/2022]
Abstract
Mantle cell lymphoma is an aggressive malignant B-cell disorder that often presents with a leukemic picture. Circulating lymphoma cell morphology may vary from small round mature-appearing lymphocytes resembling the lymphocytes of chronic lymphocytic leukemia to large prolymphocytoid or blastoid cells. Rare reports of hyperleukocytosis with leukostasis, treated with leukocytapheresis, are described in patients with prolymphocytoid or blastoid morphology. We report an 88 year old woman with mantle cell lymphoma, hyperleukocytosis (WBC > 400 × 10(3) /µL) with severe respiratory compromise but without interstitial or alveolar infiltrates on radiograph or computerized tomography of the chest. She was afebrile and had no central nervous system signs. Circulating lymphoma cell morphology was predominantly of the small lymphocyte type. A two-whole-blood-volume leukocytapheresis reduced her WBC from 465 to 221 × 10(3) /µL in 150 min. Her respiratory rate decreased from 28/min to 18/min and her arterial oxygen saturation (SpO2 ) rose from 91% to 97% on 6 L/min of oxygen by nasal cannula. Severe breathlessness before the procedure abated completely by the end of the procedure. Respiratory compromise may occur in mantle cell lymphoma with hyperleukocytosis with a mature lymphoma cell phenotype, even without a clear picture of leukostasis. Although the ultimate survival of the patient depends on treatment with chemotherapy, leukocytapheresis for alleviation of symptoms may be warranted and should be considered. Respiratory status and response to leukocytapheresis should be documented with physiological measurements. J. Clin. Apheresis 31:398-402, 2016. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Laura Kwan
- Transfusion Medicine and Apheresis Service.,Department of Pathology.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Jeanne Linden
- Transfusion Medicine and Apheresis Service.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Kathleen Gaffney
- Transfusion Medicine and Apheresis Service.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Mindy Greene
- Transfusion Medicine and Apheresis Service.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Michelle Vauthrin
- Transfusion Medicine and Apheresis Service.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Muthalagu Ramanathan
- Division of Hematology/Oncology.,Department of Medicine.,University of Massachusetts Medical School, Worcester, Massachusetts.,UMass Memorial Medical Center, Worcester, Massachusetts
| | - Robert Weinstein
- Transfusion Medicine and Apheresis Service.,Division of Transfusion Medicine.,Department of Medicine.,Department of Pathology.,University of Massachusetts Medical School, Worcester, Massachusetts.,UMass Memorial Medical Center, Worcester, Massachusetts
| |
Collapse
|
20
|
Pham HP, Schwartz J. How we approach a patient with symptoms of leukostasis requiring emergent leukocytapheresis. Transfusion 2015; 55:2306-11; quiz 2305. [PMID: 26267387 DOI: 10.1111/trf.13210] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/17/2015] [Accepted: 05/17/2015] [Indexed: 01/26/2023]
Abstract
Hyperleukocytosis can induce leukostasis, which can lead to vascular obstructions (usually in the lungs and central nervous system), tumor lysis syndrome, and disseminated intravascular coagulation. Although it has not been conclusively shown to improve long-term outcome, leukocytapheresis may be used as part of the management of hyperleukocytosis with or without leukostasis to rapidly reduce the white blood cell (WBC) burden. Since leukocytapheresis only temporarily decreases the WBC count, early initiation of more definite therapy, such as hydroxyurea and/or chemotherapy, is essential. In this article, clinical assessment of the patient's clinical status to determine the need for leukocytapheresis as well as a general guideline for management of the technical aspects and complications of the procedure are discussed.
Collapse
Affiliation(s)
- Huy P Pham
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital, New York, New York
| |
Collapse
|
21
|
Galera P, Haynes S, Sulmasy P, Bailey JA, Greene M, Vauthrin M, Brettler D, Liebmann J, Mark Madison J, Weinstein R. Physiological measurements corroborate symptomatic improvement after therapeutic leukapheresis in a pregnant woman with chronic myelogenous leukemia. J Clin Apher 2015; 31:393-7. [PMID: 26053950 DOI: 10.1002/jca.21410] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/04/2015] [Accepted: 05/17/2015] [Indexed: 11/07/2022]
Abstract
Therapeutic leukapheresis can control the white blood cell count (WBC) of pregnant women with chronic myelogenous leukemia (CML) who have hyperleukocytosis without leukostasis. The medical justification for this treatment has not been objectively documented. We report a 27-year-old woman, diagnosed with CML at 10-week gestation, who developed severe dyspnea on exertion. A workup that included chest CT and echocardiography with a bubble study detected no cardiopulmonary pathology to explain her symptoms, and thus she was referred for leukapheresis. Prior to her first leukapheresis, which lowered her WBC from 154 × 10(3) /μL to 133 × 10(3) /μL, her oxygen saturation (SpO2 ) on room air decreased from 98 to 93% during 100 feet of slow ambulation and she was dyspneic. Just after the leukapheresis, her dyspnea on exertion was much improved and her SpO2 remained at 98% with repeat ambulation. Spirometry and lung volume studies obtained before and after her first leukapheresis demonstrated 32 and 31% improvements in forced vital capacity and forced expiratory volume in 1 s respectively, a 25% increase in functional residual capacity, and a 142% improvement in expiratory reserve volume. Residual volume decreased by almost 20%. Three times in a week, leukapheresis was continued until her WBC was controlled with interferon α-2b approximately 4 weeks later. Her dyspnea had completely resolved. She gave birth by elective caesarean section to a healthy boy at 32 weeks. Corroboration of symptom relief by leukapheresis with physiological data may justify such treatment in pregnant patients with CML. J. Clin. Apheresis 31:393-397, 2016. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Pallavi Galera
- Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts.,Department of Pathology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Stefanie Haynes
- Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Paula Sulmasy
- Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Jeffrey A Bailey
- Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts.,Department of Pathology, UMass Memorial Medical Center, Worcester, Massachusetts.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Transfusion Medicine, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Mindy Greene
- Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Michelle Vauthrin
- Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Doreen Brettler
- Department of Pathology, UMass Memorial Medical Center, Worcester, Massachusetts.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Hematology/Oncology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - James Liebmann
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Hematology/Oncology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - J Mark Madison
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert Weinstein
- Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts.,Department of Pathology, UMass Memorial Medical Center, Worcester, Massachusetts.,Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Transfusion Medicine, UMass Memorial Medical Center, Worcester, Massachusetts
| |
Collapse
|
22
|
How I treat hyperleukocytosis in acute myeloid leukemia. Blood 2015; 125:3246-52. [DOI: 10.1182/blood-2014-10-551507] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/02/2015] [Indexed: 12/18/2022] Open
Abstract
Abstract
Hyperleukocytosis (HL) per se is a laboratory abnormality, commonly defined by a white blood cell count >100 000/µL, caused by leukemic cell proliferation. Not the high blood count itself, but complications such as leukostasis, tumor lysis syndrome, and disseminated intravascular coagulation put the patient at risk and require therapeutic intervention. The risk of complications is higher in acute than in chronic leukemias, and particularly leukostasis occurs more often in acute myeloid leukemia (AML) for several reasons. Only a small proportion of AML patients present with HL, but these patients have a particularly dismal prognosis because of (1) a higher risk of early death resulting from HL complications; and (2) a higher probability of relapse and death in the long run. Whereas initial high blood counts and high lactate dehydrogenase as an indicator for high proliferation are part of prognostic scores guiding risk-adapted consolidation strategies, HL at initial diagnosis must be considered a hematologic emergency and requires rapid action of the admitting physician in order to prevent early death.
Collapse
|
23
|
Brenner AK, Reikvam H, Lavecchia A, Bruserud Ø. Therapeutic targeting the cell division cycle 25 (CDC25) phosphatases in human acute myeloid leukemia--the possibility to target several kinases through inhibition of the various CDC25 isoforms. Molecules 2014; 19:18414-47. [PMID: 25397735 PMCID: PMC6270710 DOI: 10.3390/molecules191118414] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/28/2014] [Accepted: 11/02/2014] [Indexed: 01/26/2023] Open
Abstract
The cell division cycle 25 (CDC25) phosphatases include CDC25A, CDC25B and CDC25C. These three molecules are important regulators of several steps in the cell cycle, including the activation of various cyclin-dependent kinases (CDKs). CDC25s seem to have a role in the development of several human malignancies, including acute myeloid leukemia (AML); and CDC25 inhibition is therefore considered as a possible anticancer strategy. Firstly, upregulation of CDC25A can enhance cell proliferation and the expression seems to be controlled through PI3K-Akt-mTOR signaling, a pathway possibly mediating chemoresistance in human AML. Loss of CDC25A is also important for the cell cycle arrest caused by differentiation induction of malignant hematopoietic cells. Secondly, high CDC25B expression is associated with resistance against the antiproliferative effect of PI3K-Akt-mTOR inhibitors in primary human AML cells, and inhibition of this isoform seems to reduce AML cell line proliferation through effects on NFκB and p300. Finally, CDC25C seems important for the phenotype of AML cells at least for a subset of patients. Many of the identified CDC25 inhibitors show cross-reactivity among the three CDC25 isoforms. Thus, by using such cross-reactive inhibitors it may become possible to inhibit several molecular events in the regulation of cell cycle progression and even cytoplasmic signaling, including activation of several CDKs, through the use of a single drug. Such combined strategies will probably be an advantage in human cancer treatment.
Collapse
Affiliation(s)
- Annette K Brenner
- Section for Hematology, Institute of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, 5021, Norway
| | - Håkon Reikvam
- Section for Hematology, Institute of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, 5021, Norway
| | - Antonio Lavecchia
- "Drug Discovery" Laboratory, Department of Pharmacy, University of Naples Federico II, Naples 80131, Italy
| | - Øystein Bruserud
- Section for Hematology, Institute of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, 5021, Norway.
| |
Collapse
|
24
|
Gong J, Wu B, Guo T, Zhou S, He B, Peng X. Hyperleukocytosis: A report of five cases and review of the literature. Oncol Lett 2014; 8:1825-1827. [PMID: 25202418 PMCID: PMC4156199 DOI: 10.3892/ol.2014.2326] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 06/12/2014] [Indexed: 11/06/2022] Open
Abstract
Hyperleukocytosis (white blood cell count, >100×109/l), an uncommon presentation of leukemia, is associated with an increased risk of early mortality. It may present with a variety of symptoms secondary to leukostasis, a syndrome caused by the sludging of circulating leukemic blasts in the microvasculature. Adequate measures for managing this medical emergency include hydration, cytoreduction, prevention of tumor lysis and, rarely, leukapheresis in cases complicated by leukostasis and hyperviscosity syndrome. The present study reports a case series of five patients with hyperleukocytic leukemia. In addition, a review of the literature with regard to the incidence, pathophysiology, clinical manifestations and management of this laboratory abnormality is included. This study demonstrated that the central nervous system and lungs are the most common sites for leukostasis, and that emergency cases require aggressive treatment.
Collapse
Affiliation(s)
- Junmei Gong
- Department of Haematology, Chinese People's Liberation Army No. 421 Hospital, Guangzhou, Guangdong 510310, P.R. China
| | - Bijia Wu
- Department of Haematology, Chinese People's Liberation Army No. 421 Hospital, Guangzhou, Guangdong 510310, P.R. China
| | - Tianjian Guo
- Department of Haematology, Chinese People's Liberation Army No. 421 Hospital, Guangzhou, Guangdong 510310, P.R. China
| | - Silang Zhou
- Department of Haematology, Chinese People's Liberation Army No. 421 Hospital, Guangzhou, Guangdong 510310, P.R. China
| | - Benfu He
- Department of Haematology, Chinese People's Liberation Army No. 421 Hospital, Guangzhou, Guangdong 510310, P.R. China
| | - Xinzhao Peng
- Department of Haematology, Chinese People's Liberation Army No. 421 Hospital, Guangzhou, Guangdong 510310, P.R. China
| |
Collapse
|
25
|
Akkök ÇA, Bergrem A, Tangen JM. Hyperleukocytose. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:1365. [DOI: 10.4045/tidsskr.13.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|