Skip to main content
SpringerLink
Log in

Special Clinical Scenarios: Hyperleukocytosis

  • Chapter
  • First Online:
Acute Myeloid Leukemia

Part of the book series: Hematologic Malignancies ((HEMATOLOGIC))

Abstract

Acute myeloid leukemia (AML) presenting with hyperleukocytosis portends a poor diagnosis. Whether hyperleukocytosis is a sign of an inherently prognostically poor leukemia or an independent risk factor has been discussed controversially. Hyperleukocytosis indicates high tumor burden, hence tumor lysis syndrome, coagulopathy, and electrolyte disbalance are associated with the diagnosis, whether from spontaneous tumor cell disintegration or cell death from cytoreductive chemotherapy. Leukostasis is a frequent complication of hyperleukocytosis, constituting a medical emergency; prime target organs are heart, lung, kidney, and brain. Leukostasis is addressed with hyperhydration, alkalinization, anti-uremics, steroids, and sometimes leukodepletion by apheresis, but none of the measures should delay initiation of induction therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abla O, Angelini P, Di Giuseppe G, Kanani MF, Lau W, Hitzler J et al (2016) Early complications of hyperleukocytosis and leukapheresis in childhood acute leukemias. J Pediatr Hematol Oncol 38(2):111–117

    Article  CAS  Google Scholar 

  • Bertoli S, Picard M, Berard E, Griessinger E, Larrue C, Mouchel PL et al (2018) Dexamethasone in hyperleukocytic acute myeloid leukemia. Haematologica 103(6):988–998

    Article  CAS  Google Scholar 

  • Bloom R, Da Silva AMT, Bracey A (1979) Reversible respiratory failure due to intravascular leukostasis in chronic myelogenous leukemia. Relationship of oxygen transfer to leukocyte count. Am J Med 67(4):679–683

    Article  CAS  Google Scholar 

  • Bug G, Anargyrou K, Tonn T, Bialleck H, Seifried E, Hoelzer D et al (2007) Impact of leukapheresis on early death rate in adult acute myeloid leukemia presenting with hyperleukocytosis. Transfusion 47(10):1843–1850

    Article  Google Scholar 

  • Bunin NJ, Pui CH (1985) Differing complications of hyperleukocytosis in children with acute lymphoblastic or acute nonlymphoblastic leukemia. J Clin Oncol 3(12):1590–1595

    Article  CAS  Google Scholar 

  • Chang MC, Chen TY, Tang JL, Lan YJ, Chao TY, Chiu CF et al (2007) Leukapheresis and cranial irradiation in patients with hyperleukocytic acute myeloid leukemia: no impact on early mortality and intracranial hemorrhage. Am J Hematol 82(11):976–980

    Article  Google Scholar 

  • Choi MH, Choe YH, Park Y, Nah H, Kim S, Jeong SH et al (2018) The effect of therapeutic leukapheresis on early complications and outcomes in patients with acute leukemia and hyperleukocytosis: a propensity score-matched study. Transfusion 58(1):208–216

    Article  CAS  Google Scholar 

  • Cornelissen JJ, Blaise D (2016) Hematopoietic stem cell transplantation for patients with AML in first complete remission. Blood 127(1):62–70

    Article  CAS  Google Scholar 

  • Creutzig U, Ritter J, Budde M, Sutor A, Schellong G (1987) Early deaths due to hemorrhage and leukostasis in childhood acute myelogenous leukemia. Associations with hyperleukocytosis and acute monocytic leukemia. Cancer 60(12):3071–3079

    Article  CAS  Google Scholar 

  • Cuttner J, Conjalka MS, Reilly M, Goldberg J, Reisman A, Meyer RJ et al (1980) Association of monocytic leukemia in patients with extreme leukocytosis. Am J Med 69(4):555–558

    Article  CAS  Google Scholar 

  • de Jonge HJ, Valk PJ, de Bont ES, Schuringa JJ, Ossenkoppele G, Vellenga E et al (2011) Prognostic impact of white blood cell count in intermediate risk acute myeloid leukemia: relevance of mutated NPM1 and FLT3-ITD. Haematologica 96(9):1310–1317

    Article  Google Scholar 

  • DiNardo CD, Pratz K, Pullarkat V, Jonas BA, Arellano M, Becker PS et al (2019) Venetoclax combined with decitabine or azacitidine in treatment-naive, elderly patients with acute myeloid leukemia. Blood 133(1):7–17

    Article  CAS  Google Scholar 

  • Dohner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Buchner T et al (2017) Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood 129(4):424–447

    Article  Google Scholar 

  • Dombret H, Seymour JF, Butrym A, Wierzbowska A, Selleslag D, Jang JH et al (2015) International phase 3 study of azacitidine vs conventional care regimens in older patients with newly diagnosed AML with >30% blasts. Blood 126(3):291–299

    Article  CAS  Google Scholar 

  • Dutcher JP, Schiffer CA, Wiernik PH (1987) Hyperleukocytosis in adult acute nonlymphocytic leukemia: impact on remission rate and duration, and survival. J Clin Oncol 5(9):1364–1372

    Article  CAS  Google Scholar 

  • Gale RE, Green C, Allen C, Mead AJ, Burnett AK, Hills RK et al (2008) The impact of FLT3 internal tandem duplication mutant level, number, size, and interaction with NPM1 mutations in a large cohort of young adult patients with acute myeloid leukemia. Blood 111(5):2776–2784

    Article  CAS  Google Scholar 

  • Ganzel C, Becker J, Mintz PD, Lazarus HM, Rowe JM (2012) Hyperleukocytosis, leukostasis and leukapheresis: practice management. Blood Rev 26(3):117–122

    Article  Google Scholar 

  • Giles FJ, Shen Y, Kantarjian HM, Korbling MJ, O’Brien S, Anderlini P et al (2001) Leukapheresis reduces early mortality in patients with acute myeloid leukemia with high white cell counts but does not improve long- term survival. Leuk Lymphoma 42(1–2):67–73

    Article  CAS  Google Scholar 

  • Haase R, Merkel N, Diwan O, Elsner K, Kramm CM (2009) Leukapheresis and exchange transfusion in children with acute leukemia and hyperleukocytosis. A single center experience. Klin Padiatr 221(6):374–378

    Article  CAS  Google Scholar 

  • Inaba H, Fan Y, Pounds S, Geiger TL, Rubnitz JE, Ribeiro RC et al (2008) Clinical and biologic features and treatment outcome of children with newly diagnosed acute myeloid leukemia and hyperleukocytosis. Cancer 113(3):522–529

    Article  Google Scholar 

  • Kantarjian HM, Thomas XG, Dmoszynska A, Wierzbowska A, Mazur G, Mayer J et al (2012) Multicenter, randomized, open-label, phase III trial of decitabine versus patient choice, with physician advice, of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia. J Clin Oncol 30(21):2670–2677

    Article  CAS  Google Scholar 

  • Korkmaz S (2018) The management of hyperleukocytosis in 2017: do we still need leukapheresis? Transfus Apher Sci 57(1):4–7

    Article  Google Scholar 

  • Malkan UY, Ozcebe OI (2017) Leukapheresis do not improve early death rates in acute myeloid leukemia patients with hyperleukocytosis. Transfus Apher Sci 56(6):880–882

    Article  Google Scholar 

  • Marbello L, Ricci F, Nosari AM, Turrini M, Nador G, Nichelatti M et al (2008) Outcome of hyperleukocytic adult acute myeloid leukaemia: a single-center retrospective study and review of literature. Leuk Res 32(8):1221–1227

    Article  Google Scholar 

  • Nan X, Qin Q, Gentille C, Ensor J, Leveque C, Pingali SR et al (2017) Leukapheresis reduces 4-week mortality in acute myeloid leukemia patients with hyperleukocytosis—a retrospective study from a tertiary center. Leuk Lymphoma 58(9):1–11

    Article  Google Scholar 

  • Oberoi S, Lehrnbecher T, Phillips B, Hitzler J, Ethier MC, Beyene J et al (2014) Leukapheresis and low-dose chemotherapy do not reduce early mortality in acute myeloid leukemia hyperleukocytosis: a systematic review and meta-analysis. Leuk Res 38(4):460–468

    Article  Google Scholar 

  • Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E et al (2019) Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Writing Committee of the American Society for Apheresis: the eighth special issue. J Clin Apher 34(3):171–354

    Article  Google Scholar 

  • Pastore F, Pastore A, Wittmann G, Hiddemann W, Spiekermann K (2014) The role of therapeutic leukapheresis in hyperleukocytotic AML. PLoS One 9(4):e95062

    Article  Google Scholar 

  • Pham HP, Schwartz J (2015) How we approach a patient with symptoms of leukostasis requiring emergent leukocytapheresis. Transfusion 55(10):2306–2311; quiz 5

    Article  CAS  Google Scholar 

  • Porcu P, Danielson CF, Orazi A, Heerema NA, Gabig TG, McCarthy LJ (1997) Therapeutic leukapheresis in hyperleucocytic leukaemias: lack of correlation between degree of cytoreduction and early mortality rate. Br J Haematol 98(2):433–436

    Article  CAS  Google Scholar 

  • Porcu P, Cripe LD, Ng EW, Bhatia S, Danielson CM, Orazi A et al (2000) Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation and management. Leuk Lymphoma 39(1–2):1–18

    Article  CAS  Google Scholar 

  • Porcu P, Farag S, Marcucci G, Cataland SR, Kennedy MS, Bissell M (2002) Leukocytoreduction for acute leukemia. Ther Apher 6(1):15–23

    Article  Google Scholar 

  • Rollig C, Ehninger G (2015) How I treat hyperleukocytosis in acute myeloid leukemia. Blood 125(21):3246–3252

    Article  Google Scholar 

  • Schulz M, Bug G, Bialleck H, Serve H, Seifried E, Bonig H (2013) Leucodepletion for hyperleucocytosis—first report on a novel technology featuring electronic interphase management. Vox Sang 105(1):47–53

    Article  CAS  Google Scholar 

  • Stahl M, Pine A, Hendrickson JE, Litzow MR, Luger SM, Stone RM et al (2018) Beliefs and practice patterns in hyperleukocytosis management in acute myeloid leukemia: a large U.S. web-based survey(.). Leuk Lymphoma 59(11):2723–2726

    Article  Google Scholar 

  • Tien FM, Hou HA, Tsai CH, Tang JL, Chen CY, Kuo YY et al (2018) Hyperleukocytosis is associated with distinct genetic alterations and is an independent poor-risk factor in de novo acute myeloid leukemia patients. Eur J Haematol 101(1):86–94

    Article  CAS  Google Scholar 

  • Walter RB, Othus M, Borthakur G, Ravandi F, Cortes JE, Pierce SA et al (2011) Prediction of early death after induction therapy for newly diagnosed acute myeloid leukemia with pretreatment risk scores: a novel paradigm for treatment assignment. J Clin Oncol 29(33):4417–4423

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine 2, Goethe University, Frankfurt/Main, Germany

    Gesine Bug

  2. Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt/Main, Germany

    Halvard Bonig

  3. German Red Cross Blood Service Baden-Württemberg-Hessen, Frankfurt/Main, Germany

    Halvard Bonig

  4. Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA

    Halvard Bonig

Authors
  1. Gesine Bug
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Halvard Bonig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gesine Bug .

Editor information

Editors and Affiliations

  1. Medizinische Klinik und Poliklinik I, University Hospital Carl Gustav Carus, Dresden, Germany

    Christoph Röllig

  2. Department of Haematology, Amsterdam University Medical Center location VUMC, Amsterdam, Noord-Holland, The Netherlands

    Gert J. Ossenkoppele

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bug, G., Bonig, H. (2021). Special Clinical Scenarios: Hyperleukocytosis. In: Röllig, C., Ossenkoppele, G.J. (eds) Acute Myeloid Leukemia . Hematologic Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-030-72676-8_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-72676-8_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-72675-1

  • Online ISBN: 978-3-030-72676-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation