title: Physiological measurements corroborate symptomatic improvement after therapeutic leukapheresis in a pregnant woman with chronic myelogenous leukemia.
abstract: Therapeutic leukapheresis can control the white blood cell count (WBC) of pregnant women with chronic myelogenous leukemia (CML) who have hyperleukocytosis without leukostasis. The medical justification for this treatment has not been objectively documented. We report a 27-year-old woman, diagnosed with CML at 10-week gestation, who developed severe dyspnea on exertion. A workup that included chest CT and echocardiography with a bubble study detected no cardiopulmonary pathology to explain her symptoms, and thus she was referred for leukapheresis. Prior to her first leukapheresis, which lowered her WBC from 154 × 10(3) /μL to 133 × 10(3) /μL, her oxygen saturation (SpO2 ) on room air decreased from 98 to 93% during 100 feet of slow ambulation and she was dyspneic. Just after the leukapheresis, her dyspnea on exertion was much improved and her SpO2 remained at 98% with repeat ambulation. Spirometry and lung volume studies obtained before and after her first leukapheresis demonstrated 32 and 31% improvements in forced vital capacity and forced expiratory volume in 1 s respectively, a 25% increase in functional residual capacity, and a 142% improvement in expiratory reserve volume. Residual volume decreased by almost 20%. Three times in a week, leukapheresis was continued until her WBC was controlled with interferon α-2b approximately 4 weeks later. Her dyspnea had completely resolved. She gave birth by elective caesarean section to a healthy boy at 32 weeks. Corroboration of symptom relief by leukapheresis with physiological data may justify such treatment in pregnant patients with CML. J. Clin. Apheresis 31:393-397, 2016. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts.|Department of Pathology, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Galera
authors.affiliation: Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Haynes
authors.affiliation: Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Paula
authors.initials: P
authors.lastname: Sulmasy
authors.affiliation: Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts.|Department of Pathology, UMass Memorial Medical Center, Worcester, Massachusetts.|Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.|Division of Transfusion Medicine, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bailey
authors.affiliation: Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Mindy
authors.initials: M
authors.lastname: Greene
authors.affiliation: Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Michelle
authors.initials: M
authors.lastname: Vauthrin
authors.affiliation: Department of Pathology, UMass Memorial Medical Center, Worcester, Massachusetts.|Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.|Division of Hematology/Oncology, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Doreen
authors.initials: D
authors.lastname: Brettler
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.|Division of Hematology/Oncology, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: James
authors.initials: J
authors.lastname: Liebmann
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.|Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: J
authors.initials: J
authors.lastname: Mark Madison
authors.affiliation: Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts.|Department of Pathology, UMass Memorial Medical Center, Worcester, Massachusetts.|Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.|Division of Transfusion Medicine, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Robert
authors.initials: R
authors.lastname: Weinstein
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004417:Dyspnea; D005260:Female; D006801:Humans; D007937:Leukapheresis; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000503:physiopathology / Q000628:therapy*; D007958:Leukocyte Count; D050498:Live Birth; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000628:therapy*; D012123:Pulmonary Ventilation
keywords: dyspnea; hyperleukocytosis; myeloproliferative neoplasm; pulmonary function tests