Major Literature
Ganzel et al, Blood Reviews 2012- Hyperleukocytosis = WBC >100,000
- Complications associated w/ hyperleukocytosis
- Leukostasis
- Increased blood viscosity and/or endothelial activation by blasts secrete cytokines that promote more blast recruitment --> vascular obstruction
- CNS and lung most commonly affected
- CNS: confusion, dizziness, HA, tinnitus, vision change, delirium, ataxia, somnolence, coma, ICH
- Lung: SOB, tachypnea, hypoxemia, infiltrates
- Other organs
- Acute leg ischemia
- Renal vein thrombosis
- Priapism
- In pediatric ALL, leukostasis most prevalent w/ WBC >400,000
- TLS
- Due to high cell turnover
- HyperUA, hyperPhos, hyperK, hypoCa
- DIC
- Due to high cell turnover --> exposes endothelium to high levels of tissue factor --> triggers extrinsic coagulation pathway
- Why treat?
- To prevent above complications
- Chemotherapy can further increase risk of above complications if WBC high
- How do you treat?
- Hydration
- Allopurinol (chemical cytoreduction)
- Leukapheresis (mechanical cytoreduction)
- Indications
- Reduce acute sxs from leukostasis
- Prevent leukostasis
- Avoid/Reduce severity of TLS and DIC
- Efficacy
- Single cycle can reduce WBC by 20-50%
- Most authors suggest WBC <100,000 as the goal
- May reduce early death (mortality in the first 2 weeks) but no effect on cancer remission rates or overall survival
- Complications
- HypoCa from citrate toxicity
- RBC or platelet loss during the procedure
- Venous access complications (bleed, infection, thrombosis)
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