The Role of Leukapheresis in the Current Management of Hyperleukocytosis in Newly Diagnosed Childhood Acute Lymphoblastic Leukemia

Rosa Nguyen, Sima Jeha, Yinmei Zhou, Xueyuan Cao, Cheng Cheng, Deepa Bhojwani, Patrick Campbell, Scott Howard, Jeffrey Rubnitz, Raul C. Ribeiro, John T. Sandlund, Tanja Gruber, Hiroto Inaba, Ching Hon Pui, Monika L. Metzger

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Hyperleukocytosis in children with acute lymphoblastic leukemia (ALL) has been associated with early morbidity and mortality. The use of leukapheresis in these children treated with contemporary therapy remains controversial. Procedure: We analyzed clinical data from patients enrolled onto frontline protocols for ALL (Total Therapy XV and XVI) between 2003 and 2014. We documented adverse events within the first 14 days in patients with a white blood cell (WBC) count ≥200 × 10 9 /l and reviewed their management. Results: Fifty-three (7.8%) of 678 consecutive pediatric patients with newly diagnosed ALL presented with hyperleukocytosis (median WBC count 393 × 10 9 /l; range 200–1,014). Two deaths in patients without initial hyperleukocytosis occurred within the first 2 weeks from diagnosis secondary to bacterial sepsis. A total of 21 (40%) patients with ALL and hyperleukocytosis developed grade 3 or 4 adverse events regardless of the use of leukapheresis (P > 0.99 and P = 0.19). Sixteen of 53 (30%) patients with ALL received low-dose chemotherapy for leukocytoreduction initially. One-third of patients received urate oxidase, and none of the patients with hyperleukocytosis required hemodialysis. Conclusions: The early morbidity and mortality commonly associated with hyperleukocytosis in children with newly diagnosed ALL can be avoided with contemporary supportive care and conservative management possibly obviating the need for costly and potentially dangerous leukapheresis.

Original languageEnglish (US)
Pages (from-to)1546-1551
Number of pages6
JournalPediatric Blood and Cancer
Volume63
Issue number9
DOIs
StatePublished - Sep 1 2016

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Leukapheresis
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukocyte Count
Urate Oxidase
Morbidity
Mortality
Renal Dialysis
Sepsis
Pediatrics
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

The Role of Leukapheresis in the Current Management of Hyperleukocytosis in Newly Diagnosed Childhood Acute Lymphoblastic Leukemia. / Nguyen, Rosa; Jeha, Sima; Zhou, Yinmei; Cao, Xueyuan; Cheng, Cheng; Bhojwani, Deepa; Campbell, Patrick; Howard, Scott; Rubnitz, Jeffrey; Ribeiro, Raul C.; Sandlund, John T.; Gruber, Tanja; Inaba, Hiroto; Pui, Ching Hon; Metzger, Monika L.

In: Pediatric Blood and Cancer, Vol. 63, No. 9, 01.09.2016, p. 1546-1551.

Research output: Contribution to journalArticle

Nguyen, R, Jeha, S, Zhou, Y, Cao, X, Cheng, C, Bhojwani, D, Campbell, P, Howard, S, Rubnitz, J, Ribeiro, RC, Sandlund, JT, Gruber, T, Inaba, H, Pui, CH & Metzger, ML 2016, 'The Role of Leukapheresis in the Current Management of Hyperleukocytosis in Newly Diagnosed Childhood Acute Lymphoblastic Leukemia', Pediatric Blood and Cancer, vol. 63, no. 9, pp. 1546-1551. https://doi.org/10.1002/pbc.26056
Nguyen, Rosa ; Jeha, Sima ; Zhou, Yinmei ; Cao, Xueyuan ; Cheng, Cheng ; Bhojwani, Deepa ; Campbell, Patrick ; Howard, Scott ; Rubnitz, Jeffrey ; Ribeiro, Raul C. ; Sandlund, John T. ; Gruber, Tanja ; Inaba, Hiroto ; Pui, Ching Hon ; Metzger, Monika L. / The Role of Leukapheresis in the Current Management of Hyperleukocytosis in Newly Diagnosed Childhood Acute Lymphoblastic Leukemia. In: Pediatric Blood and Cancer. 2016 ; Vol. 63, No. 9. pp. 1546-1551.
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abstract = "Background: Hyperleukocytosis in children with acute lymphoblastic leukemia (ALL) has been associated with early morbidity and mortality. The use of leukapheresis in these children treated with contemporary therapy remains controversial. Procedure: We analyzed clinical data from patients enrolled onto frontline protocols for ALL (Total Therapy XV and XVI) between 2003 and 2014. We documented adverse events within the first 14 days in patients with a white blood cell (WBC) count ≥200 × 10 9 /l and reviewed their management. Results: Fifty-three (7.8{\%}) of 678 consecutive pediatric patients with newly diagnosed ALL presented with hyperleukocytosis (median WBC count 393 × 10 9 /l; range 200–1,014). Two deaths in patients without initial hyperleukocytosis occurred within the first 2 weeks from diagnosis secondary to bacterial sepsis. A total of 21 (40{\%}) patients with ALL and hyperleukocytosis developed grade 3 or 4 adverse events regardless of the use of leukapheresis (P > 0.99 and P = 0.19). Sixteen of 53 (30{\%}) patients with ALL received low-dose chemotherapy for leukocytoreduction initially. One-third of patients received urate oxidase, and none of the patients with hyperleukocytosis required hemodialysis. Conclusions: The early morbidity and mortality commonly associated with hyperleukocytosis in children with newly diagnosed ALL can be avoided with contemporary supportive care and conservative management possibly obviating the need for costly and potentially dangerous leukapheresis.",
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AU - Cao, Xueyuan

AU - Cheng, Cheng

AU - Bhojwani, Deepa

AU - Campbell, Patrick

AU - Howard, Scott

AU - Rubnitz, Jeffrey

AU - Ribeiro, Raul C.

AU - Sandlund, John T.

AU - Gruber, Tanja

AU - Inaba, Hiroto

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N2 - Background: Hyperleukocytosis in children with acute lymphoblastic leukemia (ALL) has been associated with early morbidity and mortality. The use of leukapheresis in these children treated with contemporary therapy remains controversial. Procedure: We analyzed clinical data from patients enrolled onto frontline protocols for ALL (Total Therapy XV and XVI) between 2003 and 2014. We documented adverse events within the first 14 days in patients with a white blood cell (WBC) count ≥200 × 10 9 /l and reviewed their management. Results: Fifty-three (7.8%) of 678 consecutive pediatric patients with newly diagnosed ALL presented with hyperleukocytosis (median WBC count 393 × 10 9 /l; range 200–1,014). Two deaths in patients without initial hyperleukocytosis occurred within the first 2 weeks from diagnosis secondary to bacterial sepsis. A total of 21 (40%) patients with ALL and hyperleukocytosis developed grade 3 or 4 adverse events regardless of the use of leukapheresis (P > 0.99 and P = 0.19). Sixteen of 53 (30%) patients with ALL received low-dose chemotherapy for leukocytoreduction initially. One-third of patients received urate oxidase, and none of the patients with hyperleukocytosis required hemodialysis. Conclusions: The early morbidity and mortality commonly associated with hyperleukocytosis in children with newly diagnosed ALL can be avoided with contemporary supportive care and conservative management possibly obviating the need for costly and potentially dangerous leukapheresis.

AB - Background: Hyperleukocytosis in children with acute lymphoblastic leukemia (ALL) has been associated with early morbidity and mortality. The use of leukapheresis in these children treated with contemporary therapy remains controversial. Procedure: We analyzed clinical data from patients enrolled onto frontline protocols for ALL (Total Therapy XV and XVI) between 2003 and 2014. We documented adverse events within the first 14 days in patients with a white blood cell (WBC) count ≥200 × 10 9 /l and reviewed their management. Results: Fifty-three (7.8%) of 678 consecutive pediatric patients with newly diagnosed ALL presented with hyperleukocytosis (median WBC count 393 × 10 9 /l; range 200–1,014). Two deaths in patients without initial hyperleukocytosis occurred within the first 2 weeks from diagnosis secondary to bacterial sepsis. A total of 21 (40%) patients with ALL and hyperleukocytosis developed grade 3 or 4 adverse events regardless of the use of leukapheresis (P > 0.99 and P = 0.19). Sixteen of 53 (30%) patients with ALL received low-dose chemotherapy for leukocytoreduction initially. One-third of patients received urate oxidase, and none of the patients with hyperleukocytosis required hemodialysis. Conclusions: The early morbidity and mortality commonly associated with hyperleukocytosis in children with newly diagnosed ALL can be avoided with contemporary supportive care and conservative management possibly obviating the need for costly and potentially dangerous leukapheresis.

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