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Kim, Lee, Kim, and Kim: Therapeutic Leukapheresis for the Management of Hyperleukocytosis: Ten-year Experience in a Tertiary Care Hospital
Original Article

Laboratory Medicine Online 2016; 6(3): 159-164.

Published online: 1 July 2016

DOI: https://doi.org/10.3343/lmo.2016.6.3.159

Therapeutic Leukapheresis for the Management of Hyperleukocytosis: Ten-year Experience in a Tertiary Care Hospital

Banseok Kim, M.D.1, Kyongae Lee, M.T.2, Sinyoung Kim, M.D.2, Hyun Ok Kim, M.D.2

1Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

2Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Sinyoung Kim. Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-2452, Fax: +82-2-313-0956, SYKIM@yuhs.ac

Received 20 June 2015       Revised 23 September 2015       Accepted 8 October 2015

© 2016, Laboratory Medicine Online

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Hyperleukocytosis is a medical emergency that is characterized by increased blood viscosity and predisposition to various neurological, pulmonary, and gastrointestinal complications. In addition, patients are at risk of the tumor lysis syndrome because of the increased tumor burden. Therapeutic leukapheresis is an important treatment for these emergent states. In this study, we retrospectively analyzed therapeutic leukapheresis procedures that were performed in our institution during the last 10 yr.

Methods

We retrospectively analyzed therapeutic leukapheresis procedures conducted from July 2005 to March 2015 at a tertiary care hospital. We present our observations, especially the procedural characteristics and hematological parameters before and after the aforementioned procedures.

Results

Seventy-two patients underwent a total of 146 therapeutic leukapheresis procedures. The average presenting white blood cell (WBC) count was 268×103/µL, and ranged from 54×103/µL to 673×103/µL. After an average of two sessions, a statistically significant drop in the WBC counts was observed. The average WBC removal rates during the initial and entire therapeutic leukapheresis procedures of each patient were 33% and 46%, respectively. The platelet count and hemoglobin concentration were significantly reduced.

Conclusions

Therapeutic leukapheresis significantly reduces peripheral WBC counts and is a safe and effective procedure for the treatment of hyperleukocytosis.

Keywords: Hyperleukocytosis, Therapeutic leukapheresis, Leukemia

Figures and Tables

Fig. 1

The distribution of presenting white blood cell counts (×103/µL) according to the patient's diagnosis.

Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CML, chronic myelogenous leukemia.
lmo-6-159-g001
Table 1

Characteristics of patients receiving therapeutic leukapheresis

lmo-6-159-i001
Diagnosis Number of patients Mean age (range) in years Median number of procedures/patients (range)* Presenting mean white blood cell count (×103/µL)†
ALL 30 21 (1-81) 2 (1-6) 279 (75-673)
AML 28 37 (1-80) 1 (1-4) 210 (54-449)
CML 8 28 (4-64) 2 (1-5) 374 (264-660)
Others 6 56 (8-82) 2.5 (2-4) 340 (273-405)
Total 72 31 (1-82) 2 (1-6) 268 (54-673)

*,†P=0.002, P value derived from Kruskal-Wallis test.

Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CML, chronic myelogenous leukemia.

Table 2

White blood cell (WBC) removal rate after 1st leukapheresis and entire leukapheresis procedure according to the level of presenting WBC counts

lmo-6-159-i002
Presenting WBC count (×103/µL) Number of patients Number of procedures Median number of procedures/patients (range)* WBC removal rate (%) after 1st leukapheresis† WBC removal rate (%) after entire leukapheresis‡
50-100 3 4 1 (1-2) 30 (10-48) 29 (10-43)
100-200 23 34 1 (1-2) 38 (4-76) 51 (4-84)
200-300 20 45 2 (1-6) 34 (-16-63) 39 (-16-73)
300-400 14 35 2 (1-4) 29 (-2-47) 53 (20-86)
400-500 8 17 2 (1-4) 19 (2-38) 37 (2-67)
> 500 4 11 2 (2-5) 33 (24-48) 52 (38-61)
Total 72 146 2 (1-6) 33 (-16-76) 46 (-16-86)

*P=0.016; †P=0.142; ‡P=0.208, P value derived from Kruskal-Wallis test.

Table 3

White blood cell (WBC) removal rate after 1st leukapheresis and entire leukapheresis procedure according to the diagnosis

lmo-6-159-i003
Diagnosis Number of patients Presenting WBC count (×103/µL) After 1st leukapheresis After last leukapheresis
WBC count (×103/µL) WBC removal rate (%)* WBC count (×103/µL) WBC removal rate (%)†
ALL 30 279 182 (43-512) 36 (3-76) 128 (39-418) 53 (3-86)
AML 28 210 147 (48-436) 32 (-16-68) 133 (32-436) 39 (-16-84)
CML 8 374 268 (145-477) 29 (16-45) 211 (151-287) 42 (31-60)
Others 6 340 272 (181-377) 21 (-2-34) 184 (80-288) 45 (2-80)
Total 72 268 185 (43-512) 33 (-16-76) 146 (32-436) 46 (-16-86)

*P=0.114; †P=0.109, P value derived from Kruskal-Wallis test.

Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CML, chronic myelogenous leukemia.

Table 4

Comparison of white blood cell (WBC) removal efficiency in selected patients

lmo-6-159-i004
Patient Diagnosis Number of procedures WBC count (×103/µL) Removal efficiency (%)
Before After Product (1)* (2)† (1)-(2)
1 AML #1 198 170 616 14.1 24.6 -10.5
#2 118 79 434 33.5 39.5 -6.0
2 AML #1 218 98 692 54.9 38.1 16.7
3 AML #1 151 72 636 52.6 51.3 1.3
#2 79 43 212 46.0 26.7 19.3
4 ALL #1 262 115 869 56.2 31.4 24.8
#2 115 72 465 37.5 39.0 -1.5
5 ALL #1 588 405 1,475 31.1 30.4 0.7
#2 407 309 1,444 24.0 42.4 -18.4
6 CML #1 323 223 687 31.0 16.0 15.0
#2 233 193 539 17.4 20.3 -2.9
7 MPAL #1 177 138 758 21.9 43.2 -21.3
8 ALL #1 142 80 577 43.9 44.7 -0.8
9 CML #1 419 353 464 15.8 10.6 5.2
#2 300 339 469 -13.2 15.1 -28.3
#3 281 282 427 -0.3 14.8 -15.1
10 ALL #1 177 43 224 75.7 10.5 65.2
11 ALL #1 323 172 669 46.9 17.9 29.0
#2 224 141 752 36.8 28.2 8.6
#3 159 106 677 33.4 36.6 -3.2
12 ALL #1 221 128 1,087 41.9 40.2 1.7
#2 136 101 850 25.8 65.4 -39.6
#3 167 131 723 21.3 45.5 -24.3
13 ALL #1 493 405 660 17.8 13.0 4.8
#2 407 380 734 6.7 18.0 -11.3
#3 384 280 412 27.0 10.9 16.1
#4 251 176 815 29.9 33.7 -3.8
14 AML #1 129 66 630 49.1 43.4 5.6
Average 31.4 30.4 1.0

*Removal efficiency (1)=(Before WBC count-After WBC count)/Before WBC count; †Removal efficiency (2)=(Product WBC count×Product volume)/(Before WBC count×Total blood volume).

Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CML, chronic myelogenous leukemia; MPAL, mixed phenotype acute leukemia.

Notes

This article is available from http://www.labmedonline.org

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