Leukapheresis (WBC Depletion) Treatment for Patients with Acute Leukemia and Blast Crisis Can Enable a High Percentage of Patients to Undergo Induction Chemotherapy

• Published in: Blood 2011-11, Vol.118 (21), p.4281-4281
• Main Authors: Hofmann, Jan C., Kiprov, Dobri D
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V118.21.4281.4281

Abstract 4281 Several retrospective, cohort studies have demonstrated that leukapheresis (WBC depletion) treatment in patients (pts) with acute leukemia and concurrent hyperleukocytosis and blast crisis decreases short-term mortality rate, but does not increase overall survival. However, pts selected in these studies for leukapheresis treatment are often sicker and have a higher underlying mortality rate (than pts who do not receive such treatment). No randomized controlled trials assessing the efficacy of leukapheresis in this subset of pts with acute leukemia have been performed. Between January, 2006 and June, 2010, Apheresis Care Group (ACG) treated 1,636 pts performing 13,587 therapeutic apheresis treatments (txs). Of this patient cohort, 126 (7.7%) pts had acute leukemia with clinical and/or laboratory evidence of blast crisis and received leukapheresis treatment. 77 pts had acute myelogenous leukemia (AML) and received 174 leukapheresis txs; 49 pts had acute lymphoblastic leukemia (ALL) and received 158 txs. AML pts presented with median WBC 204 × 109/L (range 66–418 × 109/L) and 87% pts had blast crisis (defined as blast percent >75% or blast count >100 × 109/L). Median age was 54 years (6.5–85 years); 61% pts were male. Of CNS or pulmonary symptoms (sxs) of leukostasis (CNS sxs defined as: headache, lethargy, confusion, or visual abnormalities; pulmonary sxs defined as: shortness of breath, hypoxia, or chest x-ray infiltrates without evidence of pneumonia), 13% pts had no sxs, 52% pts had 1 sx, and 35% pts had 2 sxs. ALL pts presented with median WBC 338 × 109/L (104–736 × 109/L) and 82% pts had blast crisis. Median age was 22 years (4–80 years); 64% pts were male. Of sxs of leukostasis, 25% pts had no sxs, 63% pts had 1 sx, and 12% pts had 2 sxs. All pts received a course of leukapheresis (Lp) with the following objectives: 1) decreasing the risk of thrombotic and hemorrhagic complications related to leukostasis, and 2) stabilizing pts for induction chemotherapy. WBC treatment goals were defined as: WBC count (ct)