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Hyperleukocytosis in Cancer Patients

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Oncologic Critical Care

Abstract

Hyperleukocytosis is characterized by rapid cell turnaround (mature and immature) with peripheral blood white blood cell (WBC) count exceeding 100,000 × 109/L in association with a malignant clone. High WBC count can lead to many lethal complications of which leukostasis, disseminated intravascular coagulation (DIC), and tumor lysis syndrome (TLS) are predominant. Symptomatic hyperleukocytosis portends poor prognosis, reflecting the aggressive nature of the biologic drivers behind this entity, and warrants emergent therapeutic interventions. In managing hyperleukocytosis, aggressive supportive care measures, leukapheresis, and hydroxyurea could be utilized until definitive therapy can be initiated to alter the symptomatic course of disease and its complications. Metabolic and coagulation abnormalities need to be frequently scrutinized and rapidly corrected to permit definitive therapy and prevent avoidable complications.

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References

  1. Bhatia R. Novel approaches to therapy in CML. Hematology Am Soc Hematol Educ Program. 2017;2017(1):115–20. https://doi.org/10.1182/asheducation-2017.1.115.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bunin NJ, Pui CH. Differing complications of hyperleukocytosis in children with acute lymphoblastic or acute nonlymphoblastic leukemia. J Clin Oncol. 1985;3(12):1590–5. https://doi.org/10.1200/JCO.1985.3.12.1590.

    Article  CAS  PubMed  Google Scholar 

  3. Byrd JC, Mrozek K, Dodge RK, Carroll AJ, Edwards CG, Arthur DC, … Leukemia Group, B. Pretreatment cytogenetic abnormalities are predictive of induction success, cumulative incidence of relapse, and overall survival in adult patients with de novo acute myeloid leukemia: results from Cancer and Leukemia Group B (CALGB 8461). Blood. 2002;100(13):4325–36. https://doi.org/10.1182/blood-2002-03-0772.

  4. Cancer Genome Atlas Research N, LeyTJ, Miller C, Ding L, Raphael BJ, Mungall AJ, … Eley G. Genomic and epigenomic landscapes of adult de novo acute myeloid leukemia. N Engl J Med. 2013;368(22):2059–74. https://doi.org/10.1056/NEJMoa1301689.

  5. Cerveira N, Lisboa S, Correia C, Bizarro S, Santos J, Torres L, … Teixeira MR. Genetic and clinical characterization of 45 acute leukemia patients with MLL gene rearrangements from a single institution. Mol Oncol. 2012;6(5):553–64. https://doi.org/10.1016/j.molonc.2012.06.004.

  6. Chang MC, Chen TY, Tang JL, Lan YJ, Chao TY, Chiu CF, Ho HT. Leukapheresis and cranial irradiation in patients with hyperleukocytic acute myeloid leukemia: no impact on early mortality and intracranial hemorrhage. Am J Hematol. 2007;82(11):976–80. https://doi.org/10.1002/ajh.20939.

    Article  PubMed  Google Scholar 

  7. Cukierman T, Gatt ME, Libster D, Goldschmidt N, Matzner Y. Chronic lymphocytic leukemia presenting with extreme hyperleukocytosis and thrombosis of the common femoral vein. Leuk Lymphoma. 2002;43(9):1865–8. https://doi.org/10.1080/1042819021000006367.

    Article  PubMed  Google Scholar 

  8. De Kouchkovsky I, Abdul-Hay M. Acute myeloid leukemia: a comprehensive review and 2016 update. Blood Cancer J. 2016;6(7):e441. https://doi.org/10.1038/bcj.2016.50.

    Article  PubMed  PubMed Central  Google Scholar 

  9. De Santis GC, Benicio MT, Oliveira LC, Falcao RP, Rego EM. Genetic mutations in patients with acute myeloid leukemia and leukostasis. Acta Haematol. 2013;130(2):95–7. https://doi.org/10.1159/000346442.

    Article  PubMed  Google Scholar 

  10. Druker BJ, Guilhot F, O’Brien SG, Gathmann I, Kantarjian H, Gattermann N, … Investigators I. Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med. 2006;355(23):2408–17. https://doi.org/10.1056/NEJMoa062867.

  11. Dutcher JP, Schiffer CA, Wiernik PH. Hyperleukocytosis in adult acute nonlymphocytic leukemia: impact on remission rate and duration, and survival. J Clin Oncol. 1987;5(9):1364–72. https://doi.org/10.1200/JCO.1987.5.9.1364.

    Article  CAS  PubMed  Google Scholar 

  12. Eguiguren JM, Schell MJ, Crist WM, Kunkel K, Rivera GK. Complications and outcome in childhood acute lymphoblastic leukemia with hyperleukocytosis. Blood. 1992;79(4):871–5.

    Article  CAS  PubMed  Google Scholar 

  13. Ganzel C, Becker J, Mintz PD, Lazarus HM, Rowe JM. Hyperleukocytosis, leukostasis and leukapheresis: practice management. Blood Rev. 2012;26(3):117–22. https://doi.org/10.1016/j.blre.2012.01.003.

    Article  PubMed  Google Scholar 

  14. Greenwood MJ, Seftel MD, Richardson C, Barbaric D, Barnett MJ, Bruyere H, … Hogge DE. Leukocyte count as a predictor of death during remission induction in acute myeloid leukemia. Leuk Lymphoma. 2006;47(7):1245–52. https://doi.org/10.1080/10428190600572673.

  15. Hehlmann R. How I treat CML blast crisis. Blood. 2012;120(4):737–47. https://doi.org/10.1182/blood-2012-03-380147.

    Article  CAS  PubMed  Google Scholar 

  16. Hess CE, Nichols AB, Hunt WB, Suratt PM. Pseudohypoxemia secondary to leukemia and thrombocytosis. N Engl J Med. 1979;301(7):361–3. https://doi.org/10.1056/NEJM197908163010706.

    Article  CAS  PubMed  Google Scholar 

  17. Hofmann WK, Heil G, Zander C, Wiebe S, Ottmann OG, Bergmann L, … Ganser A. Intensive chemotherapy with idarubicin, cytarabine, etoposide, and G-CSF priming in patients with advanced myelodysplastic syndrome and high-risk acute myeloid leukemia. Ann Hematol. 2004;83(8):498–503. https://doi.org/10.1007/s00277-004-0889-0.

  18. Jain N, O’Brien S. Targeted therapies for CLL: practical issues with the changing treatment paradigm. Blood Rev. 2016;30(3):233–44. https://doi.org/10.1016/j.blre.2015.12.002.

    Article  CAS  PubMed  Google Scholar 

  19. Johansson B, Moorman AV, Haas OA, Watmore AE, Cheung KL, Swanton S, Secker-Walker LM. Hematologic malignancies with t(4;11)(q21;q23) – a cytogenetic, morphologic, immunophenotypic and clinical study of 183 cases. European 11q23 Workshop participants. Leukemia. 1998;12(5):779–87.

    Article  CAS  PubMed  Google Scholar 

  20. Kintzel PE, Scott WL. Pseudohyperkalemia in a patient with chronic lymphoblastic leukemia and tumor lysis syndrome. J Oncol Pharm Pract. 2012;18(4):432–5. https://doi.org/10.1177/1078155211429885.

    Article  PubMed  Google Scholar 

  21. Larson RA, Dodge RK, Burns CP, Lee EJ, Stone RM, Schulman P, … et al. A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood. 1995;85(8):2025–37.

    Google Scholar 

  22. Lichtman MA, Rowe JM. Hyperleukocytic leukemias: rheological, clinical, and therapeutic considerations. Blood. 1982;60(2):279–83.

    Article  CAS  PubMed  Google Scholar 

  23. Naqvi K, Konopleva M, Ravandi F. Targeted therapies in acute myeloid leukemia: a focus on FLT-3 inhibitors and ABT199. Expert Rev Hematol. 2017;10(10):863–74. https://doi.org/10.1080/17474086.2017.1366852.

    Article  CAS  PubMed  Google Scholar 

  24. Novotny JR, Muller-Beissenhirtz H, Herget-Rosenthal S, Kribben A, Duhrsen U. Grading of symptoms in hyperleukocytic leukaemia: a clinical model for the role of different blast types and promyelocytes in the development of leukostasis syndrome. Eur J Haematol. 2005;74(6):501–10. https://doi.org/10.1111/j.1600-0609.2005.00421.x.

    Article  CAS  PubMed  Google Scholar 

  25. Oberoi S, Lehrnbecher T, Phillips B, Hitzler J, Ethier MC, Beyene J, Sung L. Leukapheresis and low-dose chemotherapy do not reduce early mortality in acute myeloid leukemia hyperleukocytosis: a systematic review and meta-analysis. Leuk Res. 2014;38(4):460–8. https://doi.org/10.1016/j.leukres.2014.01.004.

    Article  PubMed  Google Scholar 

  26. Patel JP, Gonen M, Figueroa ME, Fernandez H, Sun Z, Racevskis J, … Levine RL. Prognostic relevance of integrated genetic profiling in acute myeloid leukemia. N Engl J Med. 2012;366(12):1079–89. https://doi.org/10.1056/NEJMoa1112304.

  27. Piccirillo N, Laurenti L, Chiusolo P, Sora F, Bianchi M, De Matteis S, … Sica S. Reliability of leukostasis grading score to identify patients with high-risk hyperleukocytosis. Am J Hematol. 2009;84(6):381–2. https://doi.org/10.1002/ajh.21418.

  28. Porcu P, Cripe LD, Ng EW, Bhatia S, Danielson CM, Orazi A, McCarthy LJ. Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation and management. Leuk Lymphoma. 2000;39(1–2):1–18. https://doi.org/10.3109/10428190009053534.

    Article  CAS  PubMed  Google Scholar 

  29. Pui CH, Frankel LS, Carroll AJ, Raimondi SC, Shuster JJ, Head DR, … et al. Clinical characteristics and treatment outcome of childhood acute lymphoblastic leukemia with the t(4;11)(q21;q23): a collaborative study of 40 cases. Blood. 1991;77(3):440–7.

    Google Scholar 

  30. Quesnel B, Preudhomme C, Philippe N, Vanrumbeke M, Dervite I, Lai JL, … Fenaux P. p16 gene homozygous deletions in acute lymphoblastic leukemia. Blood. 1995;85(3):657–63.

    Google Scholar 

  31. Sanz MA, Grimwade D, Tallman MS, Lowenberg B, Fenaux P, Estey EH, … Lo-Coco F. Management of acute promyelocytic leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet. Blood. 2009;113(9):1875–91. https://doi.org/10.1182/blood-2008-04-150250.

  32. Terwilliger T, Abdul-Hay M. Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood Cancer J. 2017;7(6):e577. https://doi.org/10.1038/bcj.2017.53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Tien FM., Hou HA, Tsai CH, Tang JL, Chen CY, Kuo YY, … Tien HF. Hyperleukocytosis is associated with distinct genetic alterations and is an independent poor-risk factor in de novo acute myeloid leukemia patients. Eur J Haematol. 2018. https://doi.org/10.1111/ejh.13073.

  34. Zuckerman T, Ganzel C, Tallman MS, Rowe JM. How I treat hematologic emergencies in adults with acute leukemia. Blood. 2012;120(10):1993–2002. https://doi.org/10.1182/blood-2012-04-424440.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Hematologic Malignancy and Stem Cell Transplant, Yale School of Medicine, New Haven, CT, USA

    Lohith Gowda

  2. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Chitra Hosing

Authors
  1. Lohith Gowda
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  2. Chitra Hosing
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Correspondence to Chitra Hosing .

Editor information

Editors and Affiliations

  1. Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joseph L. Nates

  2. Division of Anesthesiology, Critical Care and Pain Medicine, Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kristen J. Price

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Gowda, L., Hosing, C. (2020). Hyperleukocytosis in Cancer Patients. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74588-6_94

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  • DOI: https://doi.org/10.1007/978-3-319-74588-6_94

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74587-9

  • Online ISBN: 978-3-319-74588-6

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