title: Pre-treatment with oral hydroxyurea prior to intensive chemotherapy improves early survival of patients with high hyperleukocytosis in acute myeloid leukemia.
abstract: Acute myeloid leukemia with high white blood cell count (WBC) is a medical emergency. A reduction of tumor burden with hydroxyurea may prevent life-threatening complications induced by straight chemotherapy. To evaluate this strategy, we reviewed medical charts of adult patients admitted to our institution from 1997 to 2011 with non-promyelocytic AML and WBC over 50 G/L. One hundred and sixty patients were included with a median WBC of 120 G/L (range 50-450), 107 patients received hydroxyurea prior to chemotherapy, and 53 received emergency induction chemotherapy (CT). Hospital mortality was lower for patients treated with hydroxyurea (34% versus 19%, p = 0.047) even after adjusting for age (p < 0.01) and initial WBC count (p = 0.02). No evidence of any difference between treatment groups in terms of WBC decline kinetics and disease free survival (p = 0.87) was found. Oral hydroxyurea prior to chemotherapy seems a safe and efficient strategy to reduce early death of hyperleukocytic AML patients.
authors: a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;
authors: Anne-Claire
authors: AC
authors: Mamez
authors: b Department of Hematology , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;|c EA-3518, Institut Universitaire D'hématologie Université Paris Diderot , Paris , France ;
authors: Emmanuel
authors: E
authors: Raffoux
authors: d Biostatistic Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;|e ECSTRA Team, CRESS (UMR 1153), Inserm , Université Paris Diderot , Paris , France.
authors: Sylvie
authors: S
authors: Chevret
authors: a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;
authors: Virginie
authors: V
authors: Lemiale
authors: b Department of Hematology , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;|c EA-3518, Institut Universitaire D'hématologie Université Paris Diderot , Paris , France ;
authors: Nicolas
authors: N
authors: Boissel
authors: a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;|e ECSTRA Team, CRESS (UMR 1153), Inserm , Université Paris Diderot , Paris , France.
authors: Emmanuel
authors: E
authors: Canet
authors: a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;
authors: Benoît
authors: B
authors: Schlemmer
authors: b Department of Hematology , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;|c EA-3518, Institut Universitaire D'hématologie Université Paris Diderot , Paris , France ;
authors: Hervé
authors: H
authors: Dombret
authors: a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;|e ECSTRA Team, CRESS (UMR 1153), Inserm , Université Paris Diderot , Paris , France.
authors: Elie
authors: E
authors: Azoulay
authors: a Medical Intensive Care Unit , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;|b Department of Hematology , Hôpital Saint-Louis, APHP, Université Paris Diderot , Paris , France ;|c EA-3518, Institut Universitaire D'hématologie Université Paris Diderot , Paris , France ;
authors: Etienne
authors: E
authors: Lengliné
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage / Q000627:therapeutic use*; D060828:Induction Chemotherapy; D015470:Leukemia, Myeloid, Acute / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016896:Treatment Outcome
chemical_list: D006918:Hydroxyurea
keywords: Acute myeloid leukemia; acute respiratory failure; hydroxyurea; hyperleukocytosis; leukostasis