Leukocytapheresis for patients with acute myeloid leukemia presenting with hyperleukocytosis and leukostasis: a contemporary appraisal of outcomes and benefits.

Leukocytapheresis for patients with acute myeloid leukemia presenting with hyperleukocytosis and leukostasis: a contemporary appraisal of outcomes and benefits. Expert Rev Hematol. 2020 Apr 04;: Authors: Shallis RM, Stahl M, Bewersdorf JP, Hendrickson JE, Zeidan AM Abstract Introduction: Hyperleukocytosis, defined as a total white blood cell count (WBC) >50 or more commonly >100 x 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...
Source: Expert Review of Hematology - Category: Hematology Tags: Expert Rev Hematol Source Type: research