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Hyperleucocytosis in paediatric acute myeloid leukaemia - the challenge of white blood cell counts above 200 × 10(9) /l. The NOPHO experience 1984-2014.

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Authors
Zeller, Bernward
Glosli, Heidi
Forestier, Erik
Ha, Shau-Yin
Jahnukainen, Kirsi
Jónsson, Ólafur G
Lausen, Birgitte
Palle, Josefine
Hasle, Henrik
Abrahamsson, Jonas
Issue Date
2017-08

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Citation
Hyperleucocytosis in paediatric acute myeloid leukaemia - the challenge of white blood cell counts above 200 × 10(9) /l. The NOPHO experience 1984-2014. 2017, 178 (3):448-456 Br. J. Haematol.
Abstract
Hyperleucocytosis in paediatric acute myeloid leukaemia (AML) is associated with increased morbidity and mortality. We studied hyperleucocytosis in 890 patients with AML aged 0-18 years registered in the Nordic Society of Paediatric Haematology and Oncology (NOPHO) registry, with special focus on very high white blood cell counts (WBC >200 × 10/l). Eighty-six patients (10%) had WBC 100-199 × 10(9) /l and 57 (6%) had WBC ≥200 × 10(9) /l. Patients with WBC ≥200 × 10(9) /l had a high frequency of t(9;11) and a paucity of trisomy 8. Due to the high frequency of deaths within the first 2 weeks (30% vs. 1% for all others), overall survival in this group was inferior to patients with WBC <200 × 10(9) /l (39% vs. 61%). Main cause of early death was intracranial haemorrhage and leucostasis. Twenty-six per cent of these patients never started antileukaemic protocol therapy. Leukapheresis or exchange transfusion was used in 24% of patients with hyperleucocytosis without impact on survival. Patients with hyperleucocytosis surviving the first week had identical survival as patients with lower WBC. We conclude that death within the first days after diagnosis is the major challenge in patients with high WBC and advocate rapid initiation of intensive chemotherapy.
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http://onlinelibrary.wiley.com/doi/10.1111/bjh.14692/epdf
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Archived with thanks to British journal of haematology
ae974a485f413a2113503eed53cd6c53
10.1111/bjh.14692
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English Journal Articles (Peer Reviewed)

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