Management of hyperleukocytosis in pediatric acute myeloid leukemia using immediate chemotherapy without leukapheresis: results from the NOPHO-DBH AML 2012 Protocol
Bernward Zeller,
Nira Arad-Cohen,
Daniel Cheuk,
Barbara De Moerloose,
Jose M. Fernandez Navarro,
Henrik Hasle,
Kirsi Jahnukainen,
Kristian Lovvik Juul-Dam,
Gertjan Kaspers,
Zanna Kovalova,
Olafur G. Jonsson,
Birgitte Lausen,
Monica Munthe-Kaas,
Ulrika Noren Nystrom,
Josefine Palle,
Ramune Pasauliene,
Cornelis J. Pronk,
Kadri Saks,
Anne Tierens,
Jonas Abrahamsson
Affiliations
Bernward Zeller
Department of Pediatric Hematology-Oncology, Oslo University Hospital, Oslo
Nira Arad-Cohen
Department of Pediatric Hemato-Oncology, Rambam Health Care Campus, Haifa
Daniel Cheuk
Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital and Hong Kong Pediatric Hematology and Oncology Study Group (HKPHOSG), Hong Kong
Barbara De Moerloose
Department of Pediatric Hematology-Oncology, Ghent University Hospital, Gent
Jose M. Fernandez Navarro
Department of Pediatric Hemato-Oncology, Hospital Universitario y Politecnico La Fe, Valencia
Henrik Hasle
Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus
Kirsi Jahnukainen
New Children's hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Kristian Lovvik Juul-Dam
Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus
Gertjan Kaspers
Princess Maxima Center for Pediatric Oncology, Utrecht, and Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam
Zanna Kovalova
Department of Pediatric Oncology/Hematology, Children's Clinical University Hospital, Riga, Latvia
Olafur G. Jonsson
Department of Pediatrics, Landspitali University Hospital, Reykjavik, Iceland
Birgitte Lausen
Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen
Monica Munthe-Kaas
Department of Pediatric Hematology-Oncology, Oslo University Hospital, Oslo
Ulrika Noren Nystrom
Department of Clinical Sciences, Pediatrics, Umea University, Umea
Josefine Palle
Department of Women's and Children's Health, Uppsala University, Uppsala
Ramune Pasauliene
Center of Oncology and Hematology, BMT Unit, Vilnius University Children’s Hospital, Vilnius, Lithuania
Cornelis J. Pronk
Childhood Cancer Center, Skane University Hospital, Lund
Kadri Saks
Department of Pediatrics, SA Tallinna Lastehaigla, Tallinn, Estonia
Anne Tierens
Laboratory Medicine Program, Hematopathology, University Health Network, Toronto, ON, Canada
Jonas Abrahamsson
Institution for Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg
Hyperleukocytosis (HL) in pediatric acute myeloid leukemia (AML) is associated with severe complications and inferior outcome. We report results on HL patients included in the NOPHO-DBH AML 2012 study. We recommended immediate start of full dose chemotherapy (etoposide [ETO] monotherapy for 5 days as part of the first course), avoiding leukapheresis (LA) and prephase chemotherapy (PCT). Of 714 included patients, 122 (17.1%) had HL, and 111 were treated according to the recommendations with ETO upfront without preceding LA or PCT. The first dose was applied the same day as the AML diagnosis or the day after in 94%. ETO was administered via peripheral veins in 37% of patients without major complications. After initiation of ETO the remaining WBC on days 2-5 was 69%, 36%, 17% and 8% of the pre-treatment level. On day 3, 81% had a WBC
