Jones Sandra Renee, Rahrig April, Saraf Amanda J
Department of Internal Medicine, University of Miami and Jackson Memorial Hospital Internal Medicine Residency Program, Miami, FL 33136, USA.
Division of Pediatric Hematology & Oncology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Children (Basel). 2022 Apr 2;9(4):503. doi: 10.3390/children9040503.
Hyperleukocytosis in pediatric acute leukemia is associated with increased morbidity and mortality and at present there is no consensus on the use of leukapheresis (LPH) for its management. Our aim was to review characteristics and outcomes of newly diagnosed leukemia patients with hyperleukocytosis (HL) comparing those who received LPH and those who did not. An IRB approved retrospective case control study reviewed data from a single institution over a 10 year period. At our institution, LPH was used in 8 of 62 (13%) patients with hyperleukocytosis with minimal complications. Mean leukocyte count in patients who received LPH versus those who did not was 498 k cells/mm and 237 k cells/mm, respectively. Patients who had symptoms of neurologic (63 vs. 17%) or pulmonary leukostasis (75 vs. 17%) were more likely to have undergone leukapheresis. The time from presentation to the initiation of chemotherapy was not different between those who received LPH and those who did not (mean of 35 h vs. 34 h). There was one death in the LPH group, that was the result of neurologic sequelae of hyperleukocytosis and not LPH itself. The use of LPH in patients with hyperleukocytosis is safe, well tolerated and does not alter time to chemotherapy at our institution.
小儿急性白血病中的高白细胞血症与发病率和死亡率增加相关，目前对于采用白细胞单采术（LPH）治疗高白细胞血症尚无共识。我们的目的是比较接受LPH治疗和未接受LPH治疗的新诊断高白细胞血症（HL）白血病患者的特征和转归。一项经机构审查委员会批准的回顾性病例对照研究回顾了某单一机构10年间的数据。在我们机构，62例高白细胞血症患者中有8例（13%）接受了LPH治疗，并发症极少。接受LPH治疗的患者与未接受LPH治疗的患者的平均白细胞计数分别为498k个细胞/mm³和237k个细胞/mm³。出现神经症状（63%对17%）或肺部白细胞淤滞症状（75%对17%）的患者更有可能接受白细胞单采术。接受LPH治疗的患者与未接受LPH治疗的患者从就诊到开始化疗的时间无差异（平均35小时对34小时）。LPH组有1例死亡，这是高白细胞血症的神经后遗症所致，而非LPH本身导致。在我们机构，对高白细胞血症患者使用LPH是安全的，耐受性良好，且不改变开始化疗的时间。
