Journal Article

Management of hyperleukocytosis and impact of leukapheresis among patients with acute myeloid leukemia (AML) on short- and long-term clinical outcomes: a large, retrospective, multicenter, international study

Germing Ulrich, Zeidan, Amer M, McMahon, Christine M, Konig Heiko, Podoltsev, Nikolai A, Khan Irum, Manikkam, Umakanthan Jayadev, Lengline Etienne, Acuña-Cruz, Evelyn, Brunner, Andrew M, Bewersdorf, Jan Philipp, Bhatt, Vijaya R, Shallis Rory M, Fathi, Amir T, Luger Selina, Martínez-Cuadron, David, Yoo, Brendan, Gore, Steven, Cluzeau, Thomas, Raffoux Emmanuel, Ritchie, Ellen K, Roboz, Gail J, Sekeres, Mikkael A, Miller, Adam, Rodríguez-Veiga Rebeca, Wei, Wei, Montesinos Pau, Itzykson Raphaël, Cano, Isabel, Boluda Blanca, Mukherjee Sudipto, Stahl Maximilian, Neukirchen, Judith, Tormo Mar, Rabinovich, Emma, Rabian Florence

2020

Overview

Hyperleukocytosis in acute myeloid leukemia (AML) is associated with inferior outcomes. There is limited high quality evidence to support the benefits of leukapheresis. We retrospectively collected data from patients with newly-diagnosed AML who presented with a white cell count (WBC) >50 × 109/L to 12 centers in the United States and Europe from 2006 to 2017 and received intensive chemotherapy. Logistic regression models estimated odds ratios for 30-day mortality and achievement of composite complete remission (CRc). Cox proportional hazard models estimated hazard ratios for overall survival (OS). Among 779 patients, clinical leukostasis was reported in 27%, and leukapheresis was used in 113 patients (15%). Thirty-day mortality was 16.7% (95% CI: 13.9–19.3%). Median OS was 12.6 months (95% CI: 11.5–14.9) among all patients, and 4.5 months (95% CI: 2.7–7.1) among those ≥65 years. Use of leukapheresis did not significantly impact 30-day mortality, achievement of CRc, or OS in multivariate analysis based on available data or in analysis based on multiple imputation. Among patients with investigator-adjudicated clinical leukostasis, there were statistically significant improvements in 30-day mortality and OS with leukapheresis in unadjusted analysis, but not in multivariate analysis. Given the significant resource use, cost, and potential complications of leukapheresis, randomized studies are needed to evaluate its value.

• Publisher: Nature Publishing Group
• Subject: Acute myeloid leukemia / Chemotherapy / Complications / Cost analysis / Data collection / Leukapheresis / Leukemia / Mortality / Multivariate analysis / Myeloid leukemia / Regression analysis / Regression models / Remission / Statistical analysis / Statistical models