Chen Kuan-Hao, Liu Hsi-Che, Liang Der-Cherng, Hou Jen-Yin, Huang Ting-Huan, Chang Ching-Yi, Yeh Ting-Chi
Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, New Taipei, Taiwan.
J Formos Med Assoc. 2014 Nov;113(11):833-8. doi: 10.1016/j.jfma.2014.01.006. Epub 2014 Feb 15.
BACKGROUND/PURPOSE: Patients with acute myeloid leukemia (AML) and hyperleukocytosis, defined as an initial white blood cell (WBC) count of ≥ 100 × 10(9)/L, are often treated with leukapheresis. In this study, we have reported our experience of treating AML without leukapheresis.
From November 1, 1995, to May 31, 2012, there were 74 children (≤18 years old) with de novo AML other than acute promyelocytic leukemia. Seventeen patients had an initial WBC count ≥ 100 × 10(9)/L. Prompt chemotherapy was started within hours whereas leukapheresis was not performed.
The median age of the 17 patients with hyperleukocytosis was 7.4 years (range: 0-16 years), and the median initial WBC count was 177 × 10(9)/L (range: 117-635 × 10(9)/L). The median time between admission and initiation of chemotherapy was 4.5 hours (range: 2-72 hours) in patients with hyperleukocytosis, whereas it was 13 hours (range: 2-120 hours) in those without hyperleukocytosis. Seven patients (7/17, 41%) had one or more early complications before or during the first 2 weeks of chemotherapy. Fifteen of the 16 patients who received prompt chemotherapy achieved complete remission (93.8%), comparable with those without hyperleukocytosis (98.2%; p = 0.33).
Children with AML and hyperleukocytosis, treated with prompt chemotherapy without leukapheresis, had minimal early morbidities.
背景/目的：急性髓系白血病（AML）合并高白细胞血症（定义为初始白细胞（WBC）计数≥100×10⁹/L）的患者通常接受白细胞单采术治疗。在本研究中，我们报告了不进行白细胞单采术治疗AML的经验。
1995年11月1日至2012年5月31日，有74例年龄≤18岁的初发AML患儿（不包括急性早幼粒细胞白血病）。17例患者初始WBC计数≥100×10⁹/L。数小时内即开始快速化疗，未进行白细胞单采术。
17例高白细胞血症患者的中位年龄为7.4岁（范围：0 - 16岁），初始WBC计数中位数为177×10⁹/L（范围：117 - 635×10⁹/L）。高白细胞血症患者入院至开始化疗的中位时间为4.5小时（范围：2 - 72小时），无高白细胞血症患者为13小时（范围：2 - 120小时）。7例患者（7/17，41%）在化疗的前2周内或期间出现一种或多种早期并发症。16例接受快速化疗的患者中有15例获得完全缓解（93.8%），与无高白细胞血症患者（98.2%；p = 0.33）相当。
AML合并高白细胞血症的儿童患者，接受快速化疗而不进行白细胞单采术，早期发病率极低。
