Minimally early morbidity in children with acute myeloid leukemia and hyperleukocytosis treated with prompt chemotherapy without leukapheresis

Abstract

Patients with acute myeloid leukemia (AML) and hyperleukocytosis, defined as an initial white blood cell (WBC) count of ≥ 100 × 109/L, are often treated with leukapheresis. In this study, we have reported our experience of treating AML without leukapheresis. Methods: From November 1, 1995, to May 31, 2012, there were 74 children (≤18 years old) with de novo AML other than acute promyelocytic leukemia. Seventeen patients had an initial WBC count ≥ 100 × 109/L. Prompt chemotherapy was started within hours whereas leukapheresis was not performed. Results: The median age of the 17 patients with hyperleukocytosis was 7.4 years (range: 0–16 years), and the median initial WBC count was 177 × 109/L (range: 117–635 × 109/L). The median time between admission and initiation of chemotherapy was 4.5 hours (range: 2–72 hours) in patients with hyperleukocytosis, whereas it was 13 hours (range: 2–120 hours) in those without hyperleukocytosis. Seven patients (7/17, 41%) had one or more early complications before or during the first 2 weeks of chemotherapy. Fifteen of the 16 patients who received prompt chemotherapy achieved complete remission (93.8%), comparable with those without hyperleukocytosis (98.2%; p = 0.33). Conclusion: Children with AML and hyperleukocytosis, treated with prompt chemotherapy without leukapheresis, had minimal early morbidities.

Keywords

• acute myeloid leukemia
• chemotherapy
• children
• hyperleukocytosis
• leukapheresis