Basade M, Dhar A K, Kulkarni S S, Sastry P S, Yadav R P, Parikh B S, Pai S K, Nair C N, Kurkure P A, Advani S H
Department of Medical Oncology, Tata Memorial Hospital, Bombay, India.
Med Pediatr Oncol. 1995 Sep;25(3):204-7. doi: 10.1002/mpo.2950250308.
Childhood leukemic hyperleukocytosis poses a serious threat to life because of its associated metabolic complications. The present prospective trial utilized conservative management of childhood acute lymphoblastic leukemia with hyperleukocytosis (total white cell count equal or > 100 x 10(9)/L) by intravenous hydration, urinary alkalinization, and allopurinol presenting without severe life-threatening complications. The median reduction in WBC count was 81.51% (range: 66-98.8%) within a median period of 36 hours (range: 12-60 hours) following hospitalization. There were no failures or treatment related complications. Thus we conclude that in childhood acute lymphoblastic leukemia, hyperleukocytosis can be managed safely and effectively with intravenous hydration, urinary alkalinization, and allopurinol before starting any specific anti-leukemic chemotherapy avoiding risk-associated cranial irradiation, leukapheresis, and exchange transfusion.
儿童白血病性白细胞增多症因其相关的代谢并发症对生命构成严重威胁。本前瞻性试验采用保守治疗方法，对患有白细胞增多症（总白细胞计数等于或>100×10⁹/L）的儿童急性淋巴细胞白血病进行静脉补液、尿液碱化及使用别嘌醇治疗，未出现严重的危及生命的并发症。住院后中位36小时（范围：12 - 60小时）内白细胞计数的中位降幅为81.51%（范围：66 - 98.8%）。未出现治疗失败或与治疗相关的并发症。因此，我们得出结论，在儿童急性淋巴细胞白血病中，在开始任何特异性抗白血病化疗之前，通过静脉补液、尿液碱化及使用别嘌醇，可以安全有效地管理白细胞增多症，避免与风险相关的颅脑照射、白细胞单采术及换血疗法。
