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.
KeywordsWhite Blood Cell Acute Lymphoblastic Leukemia White Blood Cell Count Disseminate Intravascular Coagulation Chronic Myelogenous Leukemia
- Basade M, Dhar AK, Kulkarni SS et al (1995) Rapid cytoreduction in childhood leukemic hyperleukocytosis by conservative therapy. Med Pediatr Oncol 25:204–207Google Scholar
- Möricke A, Reiter A, Zimmermann M et al (2008) Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95. Blood 111:4477–4489CrossRefPubMedGoogle Scholar
- Vahdat L, Maslak P, Miller WH Jr et al (1994) Early mortality and the retinoic acid syndrome in acute promyelocytic leukemia: impact of leukocytosis, low-dose chemotherapy, PMN/RAR-alpha isoform, and CD13 expression in patients treated with all-trans retinoic acid. Blood 84:3843–3849PubMedGoogle Scholar