The effect of therapeutic leukapheresis on early complications and outcomes in patients with acute leukemia and hyperleukocytosis

a propensity score-matched study

Min Hyuk Choi, Yeon Hwa Choe, Yongjung Park, Hyunjin Nah, Sinyoung Kim, Seokhoon Jeong, Hyun Ok Kim

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Hyperleukocytosis in acute leukemia is associated with higher early mortality due to the major complications of leukostasis, tumor lysis syndrome (TLS), and disseminated intravascular coagulopathy (DIC). Leukapheresis remains an important modality for the management of patients with acute leukemia and hyperleukocytosis. However, the role of leukapheresis in early mortality is controversial. This study sought to evaluate the prognostic impact of leukapheresis and its beneficial effects on TLS and DIC. STUDY DESIGN AND METHODS: We conducted a propensity score-matched study of 166 patients with acute leukemia and hyperleukocytosis admitted between 2006 and 2016. The incidence of TLS and DIC was determined using well-defined Cairo-Bishop criteria for TLS and International Society of Thrombosis and Haemostasis criteria for DIC. RESULTS: Before matching, 27 of 91 patients (30%) with acute myeloid leukemia (AML) and 32 of 75 patients (43%) with acute lymphoblastic leukemia (ALL) underwent leukapheresis. Propensity score matching was performed to adjust for clinical disparities between the leukapheresis and without-leukapheresis groups and resulted in 22 matched pairs of patients with AML and 16 matched pairs of patients with ALL. After matching, we observed no significant difference in early mortality rates or in the incidence of TLS or DIC between the two groups of patients with AML and ALL. CONCLUSION: Although leukapheresis may rapidly reduce white blood cell counts and leukemic blasts, any positive influence of leukapheresis could not be demonstrated by an effect on survival outcome and the incidence of early complications, such as TLS and DIC. These results suggest that a routinely performed, prophylactic leukapheresis cannot be recommended.

Original languageEnglish
Pages (from-to)208-216
Number of pages9
JournalTransfusion
Volume58
Issue number1
DOIs
Publication statusPublished - 2018 Jan 1

Fingerprint

Leukapheresis
Propensity Score
Therapeutic Uses
Tumor Lysis Syndrome
Leukemia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Mortality
Incidence
Leukostasis
Hemostasis
Leukocyte Count
Thrombosis

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Choi, Min Hyuk ; Choe, Yeon Hwa ; Park, Yongjung ; Nah, Hyunjin ; Kim, Sinyoung ; Jeong, Seokhoon ; Kim, Hyun Ok. / The effect of therapeutic leukapheresis on early complications and outcomes in patients with acute leukemia and hyperleukocytosis : a propensity score-matched study. In: Transfusion. 2018 ; Vol. 58, No. 1. pp. 208-216.
@article{e3418cad3e7f4d5d80482f9d530faa4e,
title = "The effect of therapeutic leukapheresis on early complications and outcomes in patients with acute leukemia and hyperleukocytosis: a propensity score-matched study",
abstract = "BACKGROUND: Hyperleukocytosis in acute leukemia is associated with higher early mortality due to the major complications of leukostasis, tumor lysis syndrome (TLS), and disseminated intravascular coagulopathy (DIC). Leukapheresis remains an important modality for the management of patients with acute leukemia and hyperleukocytosis. However, the role of leukapheresis in early mortality is controversial. This study sought to evaluate the prognostic impact of leukapheresis and its beneficial effects on TLS and DIC. STUDY DESIGN AND METHODS: We conducted a propensity score-matched study of 166 patients with acute leukemia and hyperleukocytosis admitted between 2006 and 2016. The incidence of TLS and DIC was determined using well-defined Cairo-Bishop criteria for TLS and International Society of Thrombosis and Haemostasis criteria for DIC. RESULTS: Before matching, 27 of 91 patients (30{\%}) with acute myeloid leukemia (AML) and 32 of 75 patients (43{\%}) with acute lymphoblastic leukemia (ALL) underwent leukapheresis. Propensity score matching was performed to adjust for clinical disparities between the leukapheresis and without-leukapheresis groups and resulted in 22 matched pairs of patients with AML and 16 matched pairs of patients with ALL. After matching, we observed no significant difference in early mortality rates or in the incidence of TLS or DIC between the two groups of patients with AML and ALL. CONCLUSION: Although leukapheresis may rapidly reduce white blood cell counts and leukemic blasts, any positive influence of leukapheresis could not be demonstrated by an effect on survival outcome and the incidence of early complications, such as TLS and DIC. These results suggest that a routinely performed, prophylactic leukapheresis cannot be recommended.",
author = "Choi, {Min Hyuk} and Choe, {Yeon Hwa} and Yongjung Park and Hyunjin Nah and Sinyoung Kim and Seokhoon Jeong and Kim, {Hyun Ok}",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/trf.14329",
language = "English",
volume = "58",
pages = "208--216",
journal = "Transfusion",
issn = "0041-1132",
publisher = "Wiley-Blackwell",
number = "1",

}

The effect of therapeutic leukapheresis on early complications and outcomes in patients with acute leukemia and hyperleukocytosis : a propensity score-matched study. / Choi, Min Hyuk; Choe, Yeon Hwa; Park, Yongjung; Nah, Hyunjin; Kim, Sinyoung; Jeong, Seokhoon; Kim, Hyun Ok.

In: Transfusion, Vol. 58, No. 1, 01.01.2018, p. 208-216.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The effect of therapeutic leukapheresis on early complications and outcomes in patients with acute leukemia and hyperleukocytosis

T2 - a propensity score-matched study

AU - Choi, Min Hyuk

AU - Choe, Yeon Hwa

AU - Park, Yongjung

AU - Nah, Hyunjin

AU - Kim, Sinyoung

AU - Jeong, Seokhoon

AU - Kim, Hyun Ok

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND: Hyperleukocytosis in acute leukemia is associated with higher early mortality due to the major complications of leukostasis, tumor lysis syndrome (TLS), and disseminated intravascular coagulopathy (DIC). Leukapheresis remains an important modality for the management of patients with acute leukemia and hyperleukocytosis. However, the role of leukapheresis in early mortality is controversial. This study sought to evaluate the prognostic impact of leukapheresis and its beneficial effects on TLS and DIC. STUDY DESIGN AND METHODS: We conducted a propensity score-matched study of 166 patients with acute leukemia and hyperleukocytosis admitted between 2006 and 2016. The incidence of TLS and DIC was determined using well-defined Cairo-Bishop criteria for TLS and International Society of Thrombosis and Haemostasis criteria for DIC. RESULTS: Before matching, 27 of 91 patients (30%) with acute myeloid leukemia (AML) and 32 of 75 patients (43%) with acute lymphoblastic leukemia (ALL) underwent leukapheresis. Propensity score matching was performed to adjust for clinical disparities between the leukapheresis and without-leukapheresis groups and resulted in 22 matched pairs of patients with AML and 16 matched pairs of patients with ALL. After matching, we observed no significant difference in early mortality rates or in the incidence of TLS or DIC between the two groups of patients with AML and ALL. CONCLUSION: Although leukapheresis may rapidly reduce white blood cell counts and leukemic blasts, any positive influence of leukapheresis could not be demonstrated by an effect on survival outcome and the incidence of early complications, such as TLS and DIC. These results suggest that a routinely performed, prophylactic leukapheresis cannot be recommended.

AB - BACKGROUND: Hyperleukocytosis in acute leukemia is associated with higher early mortality due to the major complications of leukostasis, tumor lysis syndrome (TLS), and disseminated intravascular coagulopathy (DIC). Leukapheresis remains an important modality for the management of patients with acute leukemia and hyperleukocytosis. However, the role of leukapheresis in early mortality is controversial. This study sought to evaluate the prognostic impact of leukapheresis and its beneficial effects on TLS and DIC. STUDY DESIGN AND METHODS: We conducted a propensity score-matched study of 166 patients with acute leukemia and hyperleukocytosis admitted between 2006 and 2016. The incidence of TLS and DIC was determined using well-defined Cairo-Bishop criteria for TLS and International Society of Thrombosis and Haemostasis criteria for DIC. RESULTS: Before matching, 27 of 91 patients (30%) with acute myeloid leukemia (AML) and 32 of 75 patients (43%) with acute lymphoblastic leukemia (ALL) underwent leukapheresis. Propensity score matching was performed to adjust for clinical disparities between the leukapheresis and without-leukapheresis groups and resulted in 22 matched pairs of patients with AML and 16 matched pairs of patients with ALL. After matching, we observed no significant difference in early mortality rates or in the incidence of TLS or DIC between the two groups of patients with AML and ALL. CONCLUSION: Although leukapheresis may rapidly reduce white blood cell counts and leukemic blasts, any positive influence of leukapheresis could not be demonstrated by an effect on survival outcome and the incidence of early complications, such as TLS and DIC. These results suggest that a routinely performed, prophylactic leukapheresis cannot be recommended.

UR - http://www.scopus.com/inward/record.url?scp=85040197531&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040197531&partnerID=8YFLogxK

U2 - 10.1111/trf.14329

DO - 10.1111/trf.14329

M3 - Article

VL - 58

SP - 208

EP - 216

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 1

ER -