Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Leuk Lymphoma. 2022 Aug;63(8):1780-1791. doi: 10.1080/10428194.2022.2056178. Epub 2022 Mar 31.
Leukostasis is a life-threatening complication of high concentrations of circulating leukemic cells, most often myeloblasts. Effective care of patients with leukostasis involves early recognition and treatment, and aggressive management of concurrent complications of the underlying leukemia. The relatively poor prognosis in patients with leukostasis underscores the importance of the timely and effective care of this hematologic emergency. While cytoreductive measures such as hydroxyurea, corticosteroids, intravenous chemotherapy, and leukapheresis are available to urgently reduce high cell counts, characterization of the leukemia and initiation of tailored, definitive treatment is a parallel priority. However, data supporting any specific cytoreductive approach are limited, making clinical practice guided primarily by expert opinion. In this review, we discuss the pathophysiology, clinical manifestations, diagnosis, and management of leukemic hyperleukocytosis and leukostasis, with an emphasis on how to acutely manage this oncologic emergency in patients with acute myeloid leukemia, which is the most common cause of symptomatic leukostasis.
白细胞淤滞症是循环中白血病细胞（最常见的是原始粒细胞）浓度过高引起的危及生命的并发症。有效治疗白细胞淤滞症患者需要早期识别和治疗，并积极处理基础白血病的并发并发症。白细胞淤滞症患者的预后相对较差，突出了及时有效治疗这种血液学急症的重要性。虽然可以使用羟基脲、皮质类固醇、静脉化疗和白细胞分离术等细胞减少措施来紧急降低高细胞计数，但白血病的特征描述和针对性的明确治疗也是并行的重点。然而，支持任何特定细胞减少方法的数据有限，因此临床实践主要由专家意见指导。在这篇综述中，我们讨论了白血病高白细胞血症和白细胞淤滞症的病理生理学、临床表现、诊断和管理，重点介绍了如何在急性髓系白血病患者中急性处理这种肿瘤急症，因为这是引起症状性白细胞淤滞症最常见的原因。
