Therapeutic leukocytapheresis in infants and children with leukemia and hyperleukocytosis

A single institution experience

Namisha Thapa, Robin Pham, Charles Cole, Mitchell Meinershagen, Paul Bowman, Anish Ray

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Hyperleukocytosis, defined as white blood cell (WBC) count above 100 × 10 9 /L, has high early morbidity and mortality from leukostasis-related complications, namely intracranial hemorrhage and pulmonary distress. Initiating chemotherapy without prior leukocytoreduction may lead to tumor lysis syndrome (TLS). Therapeutic leukocytapheresis (TL) is used as one leukocytoreductive intervention; however, its safety and efficacy in pediatric leukemia has not been established. The purpose of this study is to evaluate safety of TL in pediatric patients and assess the efficacy of TL in reducing WBC count in pediatric leukemia. Methods: Retrospective chart review was conducted on 14 patients with acute lymphoblastic leukemia (ALL) and 5 with acute myeloid leukemia (AML) who underwent TL during the period 2000-2014 at a single institution. Results: Mean WBC count of 19 patients who received TL was 483.2 × 10 9 /L (547.1 in ALL, 304.3 in AML); a portion of patients presented with central nervous system symptoms (15%), respiratory symptoms (10%), or both (10%). TL reduced WBC count (mean 50.7% reduction after a single TL procedure; additional 17.1% reduction after a second TL procedure in 6 patients). Short-term survival immediately following TL was 100% without any major procedural complication. Mean survival time in patients with AML was 1.5 years and with ALL was 6.5 years. Conclusions: TL significantly reduces WBC number in pediatric leukemia patients as young as 22 days old. In our retrospective study, TL was not associated with any significant complications and suggests that TL is a safe initial procedure in pediatric leukemia.

Original languageEnglish
Pages (from-to)316-323
Number of pages8
JournalJournal of Clinical Apheresis
Volume33
Issue number3
DOIs
StatePublished - 1 Jun 2018

Fingerprint

Leukapheresis
Leukemia
Leukocyte Count
Pediatrics
Therapeutics
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Leukostasis
Tumor Lysis Syndrome
Safety
Blood Cell Count
Intracranial Hemorrhages

Keywords

  • acute lymphoblastic leukemia (AML)
  • acute myeloid leukemia (ALL)
  • leukostasis
  • pediatric leukemia

Cite this

Thapa, Namisha ; Pham, Robin ; Cole, Charles ; Meinershagen, Mitchell ; Bowman, Paul ; Ray, Anish. / Therapeutic leukocytapheresis in infants and children with leukemia and hyperleukocytosis : A single institution experience. In: Journal of Clinical Apheresis. 2018 ; Vol. 33, No. 3. pp. 316-323.
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title = "Therapeutic leukocytapheresis in infants and children with leukemia and hyperleukocytosis: A single institution experience",
abstract = "Background: Hyperleukocytosis, defined as white blood cell (WBC) count above 100 × 10 9 /L, has high early morbidity and mortality from leukostasis-related complications, namely intracranial hemorrhage and pulmonary distress. Initiating chemotherapy without prior leukocytoreduction may lead to tumor lysis syndrome (TLS). Therapeutic leukocytapheresis (TL) is used as one leukocytoreductive intervention; however, its safety and efficacy in pediatric leukemia has not been established. The purpose of this study is to evaluate safety of TL in pediatric patients and assess the efficacy of TL in reducing WBC count in pediatric leukemia. Methods: Retrospective chart review was conducted on 14 patients with acute lymphoblastic leukemia (ALL) and 5 with acute myeloid leukemia (AML) who underwent TL during the period 2000-2014 at a single institution. Results: Mean WBC count of 19 patients who received TL was 483.2 × 10 9 /L (547.1 in ALL, 304.3 in AML); a portion of patients presented with central nervous system symptoms (15{\%}), respiratory symptoms (10{\%}), or both (10{\%}). TL reduced WBC count (mean 50.7{\%} reduction after a single TL procedure; additional 17.1{\%} reduction after a second TL procedure in 6 patients). Short-term survival immediately following TL was 100{\%} without any major procedural complication. Mean survival time in patients with AML was 1.5 years and with ALL was 6.5 years. Conclusions: TL significantly reduces WBC number in pediatric leukemia patients as young as 22 days old. In our retrospective study, TL was not associated with any significant complications and suggests that TL is a safe initial procedure in pediatric leukemia.",
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Therapeutic leukocytapheresis in infants and children with leukemia and hyperleukocytosis : A single institution experience. / Thapa, Namisha; Pham, Robin; Cole, Charles; Meinershagen, Mitchell; Bowman, Paul; Ray, Anish.

In: Journal of Clinical Apheresis, Vol. 33, No. 3, 01.06.2018, p. 316-323.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Therapeutic leukocytapheresis in infants and children with leukemia and hyperleukocytosis

T2 - A single institution experience

AU - Thapa, Namisha

AU - Pham, Robin

AU - Cole, Charles

AU - Meinershagen, Mitchell

AU - Bowman, Paul

AU - Ray, Anish

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: Hyperleukocytosis, defined as white blood cell (WBC) count above 100 × 10 9 /L, has high early morbidity and mortality from leukostasis-related complications, namely intracranial hemorrhage and pulmonary distress. Initiating chemotherapy without prior leukocytoreduction may lead to tumor lysis syndrome (TLS). Therapeutic leukocytapheresis (TL) is used as one leukocytoreductive intervention; however, its safety and efficacy in pediatric leukemia has not been established. The purpose of this study is to evaluate safety of TL in pediatric patients and assess the efficacy of TL in reducing WBC count in pediatric leukemia. Methods: Retrospective chart review was conducted on 14 patients with acute lymphoblastic leukemia (ALL) and 5 with acute myeloid leukemia (AML) who underwent TL during the period 2000-2014 at a single institution. Results: Mean WBC count of 19 patients who received TL was 483.2 × 10 9 /L (547.1 in ALL, 304.3 in AML); a portion of patients presented with central nervous system symptoms (15%), respiratory symptoms (10%), or both (10%). TL reduced WBC count (mean 50.7% reduction after a single TL procedure; additional 17.1% reduction after a second TL procedure in 6 patients). Short-term survival immediately following TL was 100% without any major procedural complication. Mean survival time in patients with AML was 1.5 years and with ALL was 6.5 years. Conclusions: TL significantly reduces WBC number in pediatric leukemia patients as young as 22 days old. In our retrospective study, TL was not associated with any significant complications and suggests that TL is a safe initial procedure in pediatric leukemia.

AB - Background: Hyperleukocytosis, defined as white blood cell (WBC) count above 100 × 10 9 /L, has high early morbidity and mortality from leukostasis-related complications, namely intracranial hemorrhage and pulmonary distress. Initiating chemotherapy without prior leukocytoreduction may lead to tumor lysis syndrome (TLS). Therapeutic leukocytapheresis (TL) is used as one leukocytoreductive intervention; however, its safety and efficacy in pediatric leukemia has not been established. The purpose of this study is to evaluate safety of TL in pediatric patients and assess the efficacy of TL in reducing WBC count in pediatric leukemia. Methods: Retrospective chart review was conducted on 14 patients with acute lymphoblastic leukemia (ALL) and 5 with acute myeloid leukemia (AML) who underwent TL during the period 2000-2014 at a single institution. Results: Mean WBC count of 19 patients who received TL was 483.2 × 10 9 /L (547.1 in ALL, 304.3 in AML); a portion of patients presented with central nervous system symptoms (15%), respiratory symptoms (10%), or both (10%). TL reduced WBC count (mean 50.7% reduction after a single TL procedure; additional 17.1% reduction after a second TL procedure in 6 patients). Short-term survival immediately following TL was 100% without any major procedural complication. Mean survival time in patients with AML was 1.5 years and with ALL was 6.5 years. Conclusions: TL significantly reduces WBC number in pediatric leukemia patients as young as 22 days old. In our retrospective study, TL was not associated with any significant complications and suggests that TL is a safe initial procedure in pediatric leukemia.

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U2 - 10.1002/jca.21610

DO - 10.1002/jca.21610

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