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Hyperleukocytosis

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Supportive Care in Pediatric Oncology

Part of the book series: Pediatric Oncology ((PEDIATRICO))

Abstract

Hyperleukocytosis (HL) is defined as a white blood cell (WBC) count >100 × 109/L and in pediatric patients is typically seen in acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML) and chronic myelogenous leukemia (CML). Although significant gains have been made in the treatment of pediatric leukemia, HL continues to pose risk both in regard to early death and decreased overall survival. Patients with HL are at risk for acute complications due to rapid proliferation of leukemic blasts resulting in leukostasis and tumor lysis syndrome (TLS) as well as blast cell lysis leading to the release of anti- and procoagulant factors. The degree of HL that is clinically significant in pediatric ALL and AML is controversial. Here we consider the differing presentations in patients with HL and concomitant ALL, AML, and CML and potential WBC thresholds at which patients require supplementary supportive care measures in an attempt to reduce early morbidity and mortality. In addition to an analysis of the evidence behind standard care measures, the potential benefit of leukapheresis will be examined and recommendations given.

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Authors and Affiliations

  1. Department of Hematology/Oncology and BMT, Children’s Hospital of Los Angeles, Los Angeles, CA, USA

    Ana E. Aguilar MD

  2. Department of Hematology/Oncology, Children’s Hospital and Research Center Oakland, 747 52nd Street, Oakland, CA, 94609, USA

    Anurag K. Agrawal MD & James H. Feusner MD

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  1. Ana E. Aguilar MD
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  2. Anurag K. Agrawal MD
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  3. James H. Feusner MD
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Correspondence to Anurag K. Agrawal MD .

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Editors and Affiliations

  1. Department of Hematology and Oncology, Childrens Hospital & Research Center Oak, Oakland, California, USA

    James H. Feusner

  2. Hematology/Oncology, Children's Hospital and Research Center, Oakland, California, USA

    Caroline A. Hastings

  3. Hematology/Oncology, Children's Hospital and Research Center, Oakland, California, USA

    Anurag K. Agrawal

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Aguilar, A.E., Agrawal, A.K., Feusner, J.H. (2015). Hyperleukocytosis. In: Feusner, J., Hastings, C., Agrawal, A. (eds) Supportive Care in Pediatric Oncology. Pediatric Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44317-0_6

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