title: [Successful induction therapy for acute myeloid leukemia complicated with brain hemorrhage and hyperleukocytosis].
abstract: Adequate management of hyperleukocytosis in patients with acute myeloid leukemia (AML) is essential for the prevention of life-threatening complications related to leukostasis and tumor lysis syndrome, but the optimal therapeutic strategy remains unclear. We report a 15-year-old girl with newly diagnosed AML who had extreme hyperleukocytosis (leukocyte count at diagnosis, 733,000/μl) leading to a brain hemorrhage. She was initially treated with hydroxyurea, but presented with brain hemorrhage due to leukostasis and underwent leukapheresis emergently with intensive care and mechanical ventilation. Full-dose standard induction chemotherapy was initiated after achieving gradual cytoreduction (leukocyte count, 465,000/μl) within five days after the initiation of therapy with hydroxyurea and leukapheresis. These treatments were successful and she experienced no complications. The patient ultimately recovered fully and was discharged with complete remission of AML. Although the effects of hydroxyurea and leukapheresis in the setting of hyperleukocytosis are still controversial, these initial treatments may contribute to successful bridging therapy followed by subsequent induction chemotherapy, especially in AML cases with extreme hyperleukocytosis or life-threatening leukostasis.
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine.
authors.forename: Takuya
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Nana
authors.initials: N
authors.lastname: Abe
authors.forename: Etsuko
authors.initials: E
authors.lastname: Yamazaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Koyama
authors.forename: Kazuho
authors.initials: K
authors.lastname: Miyashita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tachibana
authors.forename: Aki
authors.initials: A
authors.lastname: Kamijo
authors.forename: Naoto
authors.initials: N
authors.lastname: Tomita
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigastubo
mesh_terms: D000293:Adolescent; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D007937:Leukapheresis; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D018921:Leukostasis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome