title: Exchange Transfusion and Leukapheresis in Pediatric Patients with AML With High Risk of Early Death by Bleeding and Leukostasis.
abstract: BACKGROUND
  The risk of early death (ED) by bleeding/leukostasis is high in patients with AML with hyperleukocytosis (>100,000/μl). Within the pediatric AML-BFM (Berlin-Frankfurt-Münster) 98/04 studies, emergency strategies for these children included exchange transfusion (ET) or leukapheresis (LPh). Risk factors for ED and interventions performed were analyzed.
  
  
  METHODS
  Two hundred thirty-eight of 1,251 (19%) patients with AML presented with hyperleukocytosis; 23 of 1,251 (1.8%) patients died of bleeding/leukostasis.
  
  
  RESULTS
  ED due to bleeding/leukostasis was highest at white blood cell (WBC) count >200,000/μl (14.3%). ED rates were even higher (20%) in patients with FAB (French-American-British) M4/M5 and hyperleukocytosis >200,000/μl. Patients with WBC >200,000/μl did slightly better with ET/LPh compared to those without ET/LPh (ED rate 7.5% vs. 21.2%, P = 0.055). Multivariate WBC >200,000/μl was of strongest prognostic significance for ED (P(χ(2) ) <0.0001).
  
  
  CONCLUSIONS
  Our data confirm the high risk of bleeding/leukostasis in patients with hyperleukocytosis. ET/LPh shows a trend toward reduced ED rate due to bleeding/leukostasis and is recommended at WBC >200,000/μl, and in FAB M4/M5 even at lower WBC.
authors.affiliation: Department of Pediatric Hematology and Oncology Children's Hospital, Hannover Medical School, Hannover, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Creutzig
authors.affiliation: Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Rössig
authors.affiliation: Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Dworzak
authors.affiliation: Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Stary
authors.affiliation: Department of Pediatric Oncology/Hematology, Charité University Medical Center Berlin, Berlin, Germany.
authors.forename: Arend
authors.initials: A
authors.lastname: von Stackelberg
authors.affiliation: Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Wössmann
authors.affiliation: Department of Pediatric Hematology and Oncology Children's Hospital, Hannover Medical School, Hannover, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Zimmermann
authors.affiliation: Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Reinhardt
mesh_terms: D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007937:Leukapheresis; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D018921:Leukostasis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors
keywords: bleeding; early death; exchange transfusion; leukapheresis; leukostasis; pediatric AML