Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Apr 14;9(4):e95062.
doi: 10.1371/journal.pone.0095062. eCollection 2014.

The role of therapeutic leukapheresis in hyperleukocytotic AML

Friederike Pastore  1 , Alessandro Pastore  2 , Georg Wittmann  3 , Wolfgang Hiddemann  1 , Karsten Spiekermann  1
Affiliations

The role of therapeutic leukapheresis in hyperleukocytotic AML

Friederike Pastore et al. PLoS One. .

Abstract

Purpose: Hyperleukocytosis in AML with leukostasis is a serious life-threatening condition leading to a high early mortality which requires immediate cytoreductive therapy. Therapeutic leukapheresis is currently recommended by the American Society of Apheresis in patients with a WBC>100 G/l with signs of leukostasis, but the role of prophylactic leukapheresis before clinical signs of leukostasis occur is unclear.

Patients: We retrospectively analyzed the role of leukapheresis in 52 patients (median age 60 years) with hyperleukocytotic AML with and without clinical signs of leukostasis. Since leukapheresis was performed more frequently in patients with signs of leukostasis due to the therapeutic policy in our hospital, we developed a risk score for early death within seven days after start of therapy (EDd7) to account for this selection bias and to independently measure the effect of leukapheresis on EDd7.

Results: 20 patients received leukapheresis in combination to chemotherapy compared to 32 patients who received chemotherapy only. In a multivariate logistic regression model for the estimation of the probability of EDd7 thromboplastin time and creatinine remained as independent significant parameters and were combined to create an EDd7 risk score. The effect of leukapheresis on EDd7 was evaluated in a bivariate logistic regression together with the risk score. Leukapheresis did not significantly change early mortality in all patients with a WBC≥100 G/l.

Discussion: Prophylactic leukapheresis in hyperleukocytotic patients with and without leukostasis did not improve early mortality in our retrospective study. Larger and prospective clinical trials are needed to validate the risk score and to further explore the role of leukapheresis in AML with hyperleukocytosis.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Overview of patient selection.
Figure 2
Figure 2. OS in patients with WBC≥100 G/l.
(A) in all patients (B) in patients who received either chemotherapy only or chemotherapy combined with leukapheresis. Median OS was 7.4 months (95% CI: 4.1–10.6 months) in all patients, 7.4 months (95% CI: 1.3–13.4 months) in patients receiving chemotherapy only and 8.8 months (95% CI: 1.3–16.4 months) in patients with the combination of chemotherapy and leukapheresis. Abbreviations: CI, confidence interval; HR, Hazard Ratio, OS, Overall survival;
Figure 3
Figure 3. Efficacy of reduction of WBC with chemotherapy only and chemotherapy combined with leukapheresis.
Abbreviations: WBC, white blood count.
Figure 4
Figure 4. Survival in the first 35 days according to the EDd7 Score.
Median OS was 8.8 months (95% CI: 5.4–12.3 months) in patients with a LowR score (<−2.81) and 0.2 months (95% CI: 0.03–0.3 months) in patients with a HiR score (≥−2.81). Abbreviations: CI, confidence interval; HR, Hazard Ratio; ORd35, Odds ratio for death until (≤) day 35; OS, Overall survival.
See this image and copyright information in PMC

References

    1. Giles FJ, Shen Y, Kantarjian HM, Korbling MJ, O'Brien S, et al. (2001) Leukapheresis reduces early mortality in patients with acute myeloid leukemia with high white cell counts but does not improve long- term survival. Leuk Lymphoma 42: 67–73. - PubMed
    1. Ventura GJ, Hester JP, Smith TL, Keating MJ (1988) Acute myeloblastic leukemia with hyperleukocytosis: risk factors for early mortality in induction. Am J Hematol 27: 34–37. - PubMed
    1. Stucki A, Rivier AS, Gikic M, Monai N, Schapira M, et al. (2001) Endothelial cell activation by myeloblasts: molecular mechanisms of leukostasis and leukemic cell dissemination. Blood 97: 2121–2129. - PubMed
    1. Stemmler J, Wittmann GW, Hacker U, Heinemann V (2002) Leukapheresis in chronic myelomonocytic leukemia with leukostasis syndrome: elevated serum lactate levels as an early sign of microcirculation failure. Leuk Lymphoma 43: 1427–1430. - PubMed
    1. Dutcher JP, Schiffer CA, Wiernik PH (1987) Hyperleukocytosis in adult acute nonlymphocytic leukemia: impact on remission rate and duration, and survival. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 5: 1364–1372. - PubMed

MeSH terms