Auen Thomas, Renavikar Pranav, Habib Esther, Koepsell Scott A
Department of Pathology and Microbiology, College of Medicine, Nebraska Medical Center, Omaha, Nebraska, USA.
J Clin Apher. 2023 Dec;38(6):764-769. doi: 10.1002/jca.22082. Epub 2023 Jul 30.
Chronic lymphocytic leukemia (CLL) is a clonal mature B-cell neoplasm with a typically indolent clinical course. Though most clinicians follow these neoplasms through observation alone, an aggressive transformation to prolymphocytic leukemia, diffuse large-B-cell lymphoma (Richter transformation) or classical Hodgkin lymphoma requires immediate attention. We present a case of extreme leukocytosis (>1 million/μL) in a previously diagnosed CLL patient. Due to symptomatic leukostasis, she was started on cytoreductive therapies including leukocytapheresis. After three rounds of leukocytapheresis (LCP) and concurrent chemotherapy, her white blood cell count decreased from a maximum 1262 × 10 /μL to 574 × 10 /μL. To our knowledge, CLL with symptomatic leukostasis that required therapeutic LCP is rarely reported in literature. We propose that therapeutic LCP is of value in such rare, yet dangerous settings like our case.
慢性淋巴细胞白血病（CLL）是一种克隆性成熟B细胞肿瘤，临床病程通常较为惰性。尽管大多数临床医生仅通过观察来随访这些肿瘤，但向幼淋巴细胞白血病、弥漫性大B细胞淋巴瘤（里氏转化）或经典型霍奇金淋巴瘤的侵袭性转化需要立即关注。我们报告一例先前诊断为CLL的患者出现极度白细胞增多（>100万/μL）的病例。由于出现有症状的白细胞淤滞，她开始接受包括白细胞单采术在内的细胞减灭治疗。经过三轮白细胞单采术（LCP）及同步化疗后，她的白细胞计数从最高的1262×10⁹/μL降至574×10⁹/μL。据我们所知，文献中很少报道需要治疗性LCP的有症状白细胞淤滞的CLL病例。我们认为，在像我们病例这样罕见但危险的情况下，治疗性LCP是有价值的。
