title: Complications and outcome in childhood acute lymphoblastic leukemia with hyperleukocytosis.
abstract: Hyperleukocytosis (greater than or equal to 100 x 10(9) leukocytes/L) was identified at diagnosis of acute lymphoblastic leukemia in 64 of 358 patients enrolled on St Jude Total Therapy Study XI from February 1984 to September 1988. These children received a seven-drug induction regimen followed by high-dose methotrexate, cranial irradiation at 1 year of remission, and 120 weeks of continuation therapy with rotational administration of four drug pairs. The 27 patients with leukocyte counts greater than or equal to 200 x 10(9)/L underwent initial cytoreduction via leukapheresis or exchange transfusions. The complete remission rate for patients with hyperleukocytosis (94%) was similar to that for the overall series (96%). Stepwise regression analysis showed that hyperleukocytosis was significantly associated with age less than 1 year at diagnosis, T-cell immunophenotype, leukemic cell ploidy less than or equal to 50 chromosomes, organomegaly, and elevated lactic dehydrogenase. The 27 patients with extreme hyperleukocytosis (greater than 200 x 10(9)/L) different from the other 37 children only in a higher frequency of French-American-British (FAB) L2 morphology. Estimated 4-year event-free survival (EFS) was 52% +/- 8% (SE) for patients with hyperleukocytosis versus 79% +/- 4% for patients with leukemic counts less than 100 x 10(9)/L (P less than .0001). Patients with leukocyte counts of 100 to 200 x 10(9)/L had a significantly better EFS than those with counts greater than 200 x 10(9)/L (64% +/- 10% v 34% +/- 14%; P = .04). Thus, the therapy in this trial proved satisfactory for children with leukocyte counts of 100 to 200 x 10(9)/L; further study is needed to improve the outlook for children with counts greater than 200 x 10(9)/L.
authors.affiliation: Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38101.
authors.forename: J M
authors.initials: JM
authors.lastname: Eguiguren
authors.forename: M J
authors.initials: MJ
authors.lastname: Schell
authors.forename: W M
authors.initials: WM
authors.lastname: Crist
authors.forename: K
authors.initials: K
authors.lastname: Kunkel
authors.forename: G K
authors.initials: GK
authors.lastname: Rivera
mesh_terms: D002648:Child; D002675:Child, Preschool; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D007223:Infant; D007937:Leukapheresis; D007958:Leukocyte Count; D007964:Leukocytosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008482:Mediastinum / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D011003:Ploidies; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D011379:Prognosis; D012074:Remission Induction; D013601:T-Lymphocytes / Q000276:immunology