title: Therapeutic leukapheresis in patients with leukostasis secondary to acute myelogenous leukemia.
abstract: Leukostasis is a relatively uncommon but potentially catastrophic complication of acute myelogenous leukemia (AML). Prompt leukoreduction is considered imperative to reduce the high mortality rate in this condition. Leukapheresis, usually associated with chemotherapy, is an established approach to diminish blast cell counts. We report a single center experience in managing leukostasis with leukapheresis. Fifteen patients with leukostasis of 187 patients with AML (8.02%) followed at our institution were treated with leukapheresis associated with chemotherapy. The procedures were scheduled to be performed on a daily basis until clinical improvement was achieved and WBC counts were significantly reduced. Overall and early mortalities, defined as that occurred in the first 7 days from diagnosis, were reported. A high proportion of our patients with leukostasis (46.66%) had a monocytic subtype AML (M4/M5, according to French-American-British classification). The median overall survival was 10 days, despite a significant WBC reduction after the first apheresis procedure (from 200.7 × 10⁹/L to 150.3 × 10⁹/L). Almost half of patients (7/15) had an early death. Therapeutic leukapheresis, associated or not to chemotherapy, is an effective approach to reduce WBC counts in patients with AML and leukostasis; however, this therapeutic procedure does not appear to change significantly the sombre prognosis observed in the majority of patients with this complication. Other forms of treatment must be found to reduce the high mortality rate related to leukostasis.
authors.affiliation: Center for Cell Based Therapy, Medical School of Ribeirao Preto, University of Sao Paulo, Brazil.
authors.forename: Gil Cunha
authors.initials: GC
authors.lastname: De Santis
authors.forename: Luciana Correa Oliveira
authors.initials: LC
authors.lastname: de Oliveira
authors.forename: Lucas Gabriel Maltoni
authors.initials: LG
authors.lastname: Romano
authors.forename: Benedito de Pina
authors.initials: Bde P
authors.lastname: Almeida Prado
authors.forename: Belinda Pinto
authors.initials: BP
authors.lastname: Simoes
authors.forename: Eduardo Magalhaes
authors.initials: EM
authors.lastname: Rego
authors.forename: Dimas Tadeu
authors.initials: DT
authors.lastname: Covas
authors.forename: Roberto Passetto
authors.initials: RP
authors.lastname: Falcao
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007937:Leukapheresis; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000150:complications*; D007958:Leukocyte Count; D018921:Leukostasis / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult