急性髓系白血病合并高白细胞血症患儿在未进行白细胞单采术的情况下接受快速化疗后的早期轻微发病率。

Minimally early morbidity in children with acute myeloid leukemia and hyperleukocytosis treated with prompt chemotherapy without leukapheresis.

作者信息

Chen Kuan-Hao, Liu Hsi-Che, Liang Der-Cherng, Hou Jen-Yin, Huang Ting-Huan, Chang Ching-Yi, Yeh Ting-Chi

机构信息

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.

出版信息

J Formos Med Assoc. 2014 Nov;113(11):833-8. doi: 10.1016/j.jfma.2014.01.006. Epub 2014 Feb 15.

DOI:10.1016/j.jfma.2014.01.006

PMID:24534017

Abstract

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.

METHODS

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.

RESULTS

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).

CONCLUSION

Children with AML and hyperleukocytosis, treated with prompt chemotherapy without leukapheresis, had minimal early morbidities.

摘要

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。

方法

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。

结果

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。