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Exchange Transfusion and Leukapheresis in Pediatric Patients with AML With High Risk of Early Death by Bleeding and Leukostasis

U. Creutzig, C. Rössig, M. Dworzak, J. Stary, A. von Stackelberg, W. Wössmann, M. Zimmermann, D. Reinhardt,

. 2016 ; 63 (4) : 640-5. [pub] 20151216

Language English Country United States

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc16027839

BACKGROUND: The risk of early death (ED) by bleeding/leukostasis is high in patients with AML with hyperleukocytosis (>100,000/μl). Within the pediatric AML-BFM (Berlin-Frankfurt-Münster) 98/04 studies, emergency strategies for these children included exchange transfusion (ET) or leukapheresis (LPh). Risk factors for ED and interventions performed were analyzed. PATIENTS: Two hundred thirty-eight of 1,251 (19%) patients with AML presented with hyperleukocytosis; 23 of 1,251 (1.8%) patients died of bleeding/leukostasis. RESULTS: ED due to bleeding/leukostasis was highest at white blood cell (WBC) count >200,000/μl (14.3%). ED rates were even higher (20%) in patients with FAB (French-American-British) M4/M5 and hyperleukocytosis >200,000/μl. Patients with WBC >200,000/μl did slightly better with ET/LPh compared to those without ET/LPh (ED rate 7.5% vs. 21.2%, P = 0.055). Multivariate WBC >200,000/μl was of strongest prognostic significance for ED (P(χ(2) ) <0.0001). CONCLUSION: Our data confirm the high risk of bleeding/leukostasis in patients with hyperleukocytosis. ET/LPh shows a trend toward reduced ED rate due to bleeding/leukostasis and is recommended at WBC >200,000/μl, and in FAB M4/M5 even at lower WBC.

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$a Rössig, Claudia $u Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany.
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$a Dworzak, Michael $u Department of Pediatrics, St. Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria.
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$a Stary, Jan $u Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
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$a von Stackelberg, Arend $u Department of Pediatric Oncology/Hematology, Charité University Medical Center Berlin, Berlin, Germany.
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$a Zimmermann, Martin $u Department of Pediatric Hematology and Oncology Children's Hospital, Hannover Medical School, Hannover, Germany.
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