title: Minimally early morbidity in children with acute myeloid leukemia and hyperleukocytosis treated with prompt chemotherapy without leukapheresis.
abstract: OBJECTIVE
  Patients with acute myeloid leukemia (AML) and hyperleukocytosis, defined as an initial white blood cell (WBC) count of ≥ 100 × 10(9)/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 × 10(9)/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 × 10(9)/L (range: 117-635 × 10(9)/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).
  
  
  CONCLUSIONS
  Children with AML and hyperleukocytosis, treated with prompt chemotherapy without leukapheresis, had minimal early morbidities.
authors.affiliation: Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Kuan-Hao
authors.initials: KH
authors.lastname: Chen
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, New Taipei, Taiwan.
authors.forename: Hsi-Che
authors.initials: HC
authors.lastname: Liu
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, New Taipei, Taiwan.
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Liang
authors.affiliation: Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Jen-Yin
authors.initials: JY
authors.lastname: Hou
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Ting-Huan
authors.initials: TH
authors.lastname: Huang
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Chang
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, New Taipei, Taiwan. Electronic address: yeh@ms1.mmh.org.tw.
authors.forename: Ting-Chi
authors.initials: TC
authors.lastname: Yeh
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007937:Leukapheresis; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D007958:Leukocyte Count; D007964:Leukocytosis / Q000188:drug therapy*; D008297:Male; D009017:Morbidity; D011446:Prospective Studies; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: acute myeloid leukemia; chemotherapy; children; hyperleukocytosis; leukapheresis