title: [Treatment in adult patients with acute myeloid leukemias and hyperleukocytosis at disease onset].
abstract: OBJECTIVE
  To evaluate the efficiency of the treatment policy for patients with acute myeloid leukemia (AML) and hyperleukocytosis (HL), which is aimed at preventing rapid hypercytolysis and massive tumor lysis (cytolysis) syndrome and/or at reducing the degree of the latter at the start of induction polychemotherapy.
  
  
  METHODS
  In 2010 to 2014, the Hematology Research Center, Ministry of Health of Russia, treated 92 patients with AML, out of them 18 patients were found to have white blood cell counts of 100 to 408-10(9)/1 (median, 130-10(9)/l) at the onset of the disease. All the examinees received cytoreductive therapy with hydroxyurea and, in presence of leukostasis and/or leukocytosis (≥150-10(9)/1), with leukocytapheresis. In case of reduced leukocytosis, plasmapheresis was carried out to prevent (treat) cytolysis. Daunorubicin was injected on days 3-5 of the 7+3 induction cycle.
  
  
  RESULTS
  The signs of leukostases were detected in more than half of the 18 patients with higher white blood cell counts: 13 (72%) with lung injury, including 5 of them with signs of respiratory distress syndrome, 6 (27.8%) with neurological symptomatology, 7 (38.9%) with disseminated intravascular coagulation syndrome, including 1 with intracranial hemorrhage. Cytoreduction therapy with hydroxyurea (10 mg/kg/day) was performed 1-5 (median 2) days before initiating induction chemotherapy in 17 patients; 9 patients underwent 1-2 (median 2) leukocytapheresis sessions. Sixteen patients received 1-4 (median 2) plasmapheresis sessions prior to and within the first days of the 7+3 treatment regimen. Daunorubicin (60 mg/m2) was administered to 16 patients on days 5-7 of the 7+3 cycle and to 2 patients on days 3-5 of the cycle. There were no signs of severe cytolysis with the development of multiple organ dysfunction in any patient. 50% (9/18) achieved remission after the first 7+3 cycle and 7 more examinees did after the second cycle. Thus, the remission rate was 89%; early mortality was 5.5% (1/18), three-year overall and relapse-free survival rates were 50%.
  
  
  CONCLUSIONS
  Adequate cytoreductive and accompanying therapies for AML with HL can virtually completely prevent massive tumor cytolysis syndrome and early mortality during the first days of induction chemotherapy.
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: V V
authors.initials: VV
authors.lastname: Troitskaya
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: E N
authors.initials: EN
authors.lastname: Parovichnikova
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: A N
authors.initials: AN
authors.lastname: Sokolov
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: A V
authors.initials: AV
authors.lastname: Kokhno
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: L A
authors.initials: LA
authors.lastname: Kuzmina
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: D S
authors.initials: DS
authors.lastname: Badmazhapova
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: Z T
authors.initials: ZT
authors.lastname: Fidarova
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: O A
authors.initials: OA
authors.lastname: Gavrilina
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: A A
authors.initials: AA
authors.lastname: Sidorova
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: G M
authors.initials: GM
authors.lastname: Galstyan
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: S A
authors.initials: SA
authors.lastname: Keselman
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: T V
authors.initials: TV
authors.lastname: Gaponova
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: V S
authors.initials: VS
authors.lastname: Galuzyak
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: S K
authors.initials: SK
authors.lastname: Kravchenko
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: E O
authors.initials: EO
authors.lastname: Gribanova
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: V G
authors.initials: VG
authors.lastname: Savchenko
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000150:complications / Q000628:therapy*; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult