Leukapheresis and cranial irradiation in patients with hyperleukocytic acute myeloid leukemia: No impact on early mortality and intracranial hemorrhage

Ming Chih Chang, Tsai Yun Chen, Jih Luh Tang, Yii Jenq Lan, Tsu Yi Chao, Chang Fang Chiu, Hsin Tsung Ho

Research output: Contribution to journalArticle

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Abstract

To assess the role of leukapheresis and cranial irradiation in reducing the incidence of intracranial hemorrhage (ICH) and early death in patients with hyperleukocytic acute myeloid leukemia (AML) and the impact of such treatment on survival. This study retrospectively analyzed the records of 75 patients with hyperleukocytic AML who had a white cell count over 100,000/μL. All patients had de novo AML except for two with therapy-related AML. Various factors were assessed for their impact on morbidity and mortality, particularly the role of pre-induction leukapharesis and cranial irradiation. The most significant risk factors for ICH were the presence of two or more symptoms of leukostasis (odds ratios [OR] 10.6, 95% Cl: 2.67-42.02; P = 0.001) and respiratory distress (OR 5.41, 95% CI: 1.44-20.32, P = 0.012). The most significant risk factors for early death were age ≥ 65 (OR 4.21, 95% CI: 1.45-12.21, P = 0.008), respiratory failure (OR 3.34, 95% CI: 1.24-9.50, P = 0.018), and two or more symptoms (OR 3.50 95% CI: 1.16-10.52, P = 0.026). Neither leukapheresis nor cranial irradiation were significantly associated with a decreased incidence of ICH (P = 0.349 and 0.378, respectively). Leukapheresis had no significant influence on early death (P = 0.367). The median survival patients receiving no pretreatment was 10.50 months (range 2.58-18.42) and for those receiving pretreatment 1.50 months (range 0.10-3.16; log-rank test, P = 0.062). Leukapheresis and cranial irradiation do not improve survival or decrease the incidence of ICH in adults with hyperleukocytic AML.

Original languageEnglish
Pages (from-to)976-980
Number of pages5
JournalAmerican Journal of Hematology
Volume82
Issue number11
DOIs
Publication statusPublished - Nov 2007
Externally publishedYes

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Cranial Irradiation
Leukapheresis
Intracranial Hemorrhages
Acute Myeloid Leukemia
Odds Ratio
Mortality
Survival
Incidence
Leukostasis
Respiratory Insufficiency
Cell Count
Morbidity
Therapeutics

ASJC Scopus subject areas

  • Hematology

Cite this

Leukapheresis and cranial irradiation in patients with hyperleukocytic acute myeloid leukemia : No impact on early mortality and intracranial hemorrhage. / Chang, Ming Chih; Chen, Tsai Yun; Tang, Jih Luh; Lan, Yii Jenq; Chao, Tsu Yi; Chiu, Chang Fang; Ho, Hsin Tsung.

In: American Journal of Hematology, Vol. 82, No. 11, 11.2007, p. 976-980.

Research output: Contribution to journalArticle

Chang, Ming Chih ; Chen, Tsai Yun ; Tang, Jih Luh ; Lan, Yii Jenq ; Chao, Tsu Yi ; Chiu, Chang Fang ; Ho, Hsin Tsung. / Leukapheresis and cranial irradiation in patients with hyperleukocytic acute myeloid leukemia : No impact on early mortality and intracranial hemorrhage. In: American Journal of Hematology. 2007 ; Vol. 82, No. 11. pp. 976-980.
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abstract = "To assess the role of leukapheresis and cranial irradiation in reducing the incidence of intracranial hemorrhage (ICH) and early death in patients with hyperleukocytic acute myeloid leukemia (AML) and the impact of such treatment on survival. This study retrospectively analyzed the records of 75 patients with hyperleukocytic AML who had a white cell count over 100,000/μL. All patients had de novo AML except for two with therapy-related AML. Various factors were assessed for their impact on morbidity and mortality, particularly the role of pre-induction leukapharesis and cranial irradiation. The most significant risk factors for ICH were the presence of two or more symptoms of leukostasis (odds ratios [OR] 10.6, 95{\%} Cl: 2.67-42.02; P = 0.001) and respiratory distress (OR 5.41, 95{\%} CI: 1.44-20.32, P = 0.012). The most significant risk factors for early death were age ≥ 65 (OR 4.21, 95{\%} CI: 1.45-12.21, P = 0.008), respiratory failure (OR 3.34, 95{\%} CI: 1.24-9.50, P = 0.018), and two or more symptoms (OR 3.50 95{\%} CI: 1.16-10.52, P = 0.026). Neither leukapheresis nor cranial irradiation were significantly associated with a decreased incidence of ICH (P = 0.349 and 0.378, respectively). Leukapheresis had no significant influence on early death (P = 0.367). The median survival patients receiving no pretreatment was 10.50 months (range 2.58-18.42) and for those receiving pretreatment 1.50 months (range 0.10-3.16; log-rank test, P = 0.062). Leukapheresis and cranial irradiation do not improve survival or decrease the incidence of ICH in adults with hyperleukocytic AML.",
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