Hyperleukocytosis and leukocytapheresis in acute leukaemias: Experience from a single centre and review of the literature of leukocytapheresis in acute myeloid leukaemia

摘要

Background: Hyperleukocytosis is usually defined as leukocyte count 100×109L-1 and can be seen in newly diagnosed leukaemias. Hyperleukocytic leukaemia is associated with a risk of organ failure and early death secondary to leukostasis. Mechanical removal of leukocytes by the apheresis technique, leukocytapheresis, is a therapeutic option in these patients. Methods: During a 16-year period, 16 patients were treated with leukocytapheresis (35 apheresis procedures) for hyperleukocytosis/leukostasis. We present our experience, and in addition we review previous studies of hyperleukocytosis/leukocytapheresis in patients with acute myeloid leukaemia (AML). Results: We used a highly standardised approach for leukocytapheresis in leukaemia patients with hyperleukocytosis. The average leukocytapheresis number for each patient was 2·2 (range 1-6). Median leukocyte count before apheresis was 309×109L-1 (range 104-935); the mean leukocyte count reduction was 71%, corresponding to a mean absolute reduction of 219×109L-1. No serious side effects were seen during or immediately after apheresis. Conclusions: The data suggest that our standardised technique for leukocytapheresis effectively reduced the peripheral blood leukaemia cell counts. Previous studies in AML also support the conclusion that this is a safe and effective procedure for the treatment of a potentially life-threatening complication, but apheresis should always be combined with early chemotherapy.