Evaluation of leukapheresis and leukapheresis with additional cytoreduction in acute leukemia with hyperleukocytosis

Abstract

Background Hyperleukocytosis is a high-mortality emergency that must be diagnosed and treated promptly. The treatment options are low-dose cytosine arabinoside, hydroxyurea, steroids and leukapheresis. The risks and benefits of leukapheresis and leukapheresis with cytoreductive drugs in hyperleukocytosis are unclear. Therefore, we aimed to evaluate the efficacy of leukapheresis and the effect of adding cytoreductive drugs to leukapheresis in reducing leukocyte count and mortality in our patients.
 Material and Methods Thirty-four adult patients with acute leukaemia who underwent leukapheresis were included in this retrospective study.
 Results The median age was 66.5 years old, and 88.2% of the patients were acute myeloid leukaemia. The total number of leukapheresis was 69 cycles, and the median number of the procedure was 2. The most common symptoms were associated with the pulmonary system (67.6%). The median follow-up was 17.5 days. The mean reduction of leukocyte count was 69,112/mm3, and the efficacy of leukapheresis was 40.9%. The decrease in leukocyte and platelet counts was statistically significant when compared before and after leukapheresis. The mortality rate was 76.5% during hospitalization. While 24 patients received concomitant cytoreductive drugs with leukapheresis, ten did not. There was no statistically significant difference between these groups regarding reducing leukocyte count, efficiency of leukapheresis and mortality (p values 0.857, 0.562 and 0.553).
 Conclusions In our study, we showed the efficacy of leukapheresis in hyperleukocytosis but failed to show any difference in leukocyte reduction or mortality with additional cytoreductive drugs. Leukapheresis with concomitant cytoreduction does not abolish or increase mortality.