Leukapheresis and low-dose chemotherapy do not reduce early mortality in acute myeloid leukemia hyperleukocytosis: a systematic review and meta-analysis.
The role of leukapheresis and low-dose chemotherapy is unclear in decreasing early mortality in acute myeloid leukemia (AML) patients with hyperleukocytosis. This systematic review was conducted to describe early mortality (deaths during first induction) in patients with AML with an initial white blood count≥100×10(9)L(-1) stratified by the approach to leukapheresis and hydroxyurea/low-dose chemotherapy. Twenty-one studies were included. Weighted mean early deaths rate (20 studies, 1354 patients) was 20.1% (95% confidence interval 15.0-25.1). Neither leukapheresis strategy (p=0.67) nor hydroxyurea/low-dose chemotherapy (p=0.23) influenced the early death rate. Early mortality related to hyperleukocytosis in AML is not influenced by universal or selected use of leukapheresis or hydroxyurea/low-dose chemotherapy.
Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
Sapna
S
Oberoi
Pediatric Hematology and Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany.
Thomas
T
Lehrnbecher
Leeds General Infirmary, Leeds Teaching Hospitals, NHS Trust, Leeds, UK; Centre for Reviews and Dissemination, University of York, York, UK.
Bob
B
Phillips
Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
Johann
J
Hitzler
Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
Marie-Chantal
MC
Ethier
Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada.
Joseph
J
Beyene
Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada. Electronic address: lillian.sung@sickkids.ca.
Lillian
L
Sung
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007937:Leukapheresis; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D007964:Leukocytosis / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
Acute myeloid leukemia; Early deaths; Hydroxyurea; Leukapheresis; Leukostasis