Profile and Outcome of Hyperleukocytosis in Childhood Acute Lymphoblastic Leukemia: Experience From a Tertiary Center in India

Hyperleukocytosis is an important cause of morbidity and mortality among acute leukemia patients. The data on hyperleukocytosis from this part of world is scarce. We therefore retrospectively reviewed the clinical and morbidity profile of childhood acute leukemia presenting with total leucocyte count (TLC) >100,000 over a duration of about 2.5 years at our center. Of 140 acute leukemia patients, 24 had hyperleukocytosis at presentation. All 24 patients were of lymphoid lineage. The Mean TLC was 193539(+ 92078)/microlitre, and TLC was >200000/microlitre in 16(66.67%) patients. Tumor lysis was present in 12(50%) patients, while superior mediastinal syndrome was present in 4(16.67%). Features of leukostasis were present in 6(25%) patients (2 had neurological involvement, 3 had pulmonary involvement and 1 had features of both pulmonary & neurological stasis). Renal functions were deranged in 5(20.83%) patients. Further, 11(45.8%) patients had hemorrhagic complications. All 24 patients received hyper hydration, sodium bicarbonate and allopurinol. Chemotherapy was initiated once metabolically stable. One patient died during the first induction and four relapsed during follow-up. Childhood acute leukemia with hyperleukocytosis is associated with significant morbidity which can be managed with immediate hospitalization, aggressive management with hyper hydration, allopurinol, alkalinization of the urine and intensive monitoring before beginning chemotherapy.

[1]  P. Mintz,et al.  Hyperleukocytosis, leukostasis and leukapheresis: practice management. , 2012, Blood reviews.

[2]  A. Bhat,et al.  Management of Common Oncologic Emergencies , 2011, Indian journal of pediatrics.

[3]  L. Johnson,et al.  the American Society of Hematology Conference in Miami Beach, FL, with lymphoma or leukemia at high risk for tumor lysis : Presented in part at A randomized comparison between rasburicase and allopurinol in children , 2011 .

[4]  G. Gao,et al.  Reduced tumor lysis syndrome with low dose chemotherapy for hyperleukocytic acute leukemia prior to induction therapy. , 2011, Asian Pacific journal of cancer prevention : APJCP.

[5]  R. Marwaha,et al.  Central nervous system involvement at presentation in childhood acute lymphoblastic leukemia: management experience and lessons , 2010, Leukemia & lymphoma.

[6]  C. Kramm,et al.  Leukapheresis and Exchange Transfusion in Children with Acute Leukemia and Hyperleukocytosis. A Single Center Experience , 2009, Klinische Padiatrie.

[7]  Y. Torun,et al.  Management of Hyperleukocytosis and Prevention of Tumor Lysis Syndrome with Low-Dose Prednisone Continuous Infusion in Children with Acute Lymphoblastic Leukemia , 2009, Acta Haematologica.

[8]  M. Carli,et al.  Conservative management of priapism secondary to leukemia , 2008, Pediatric blood & cancer.

[9]  C. Pui,et al.  Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  C. Pui,et al.  Early complications in children with acute lymphoblastic leukemia presenting with hyperleukocytosis , 2005, Pediatric blood & cancer.

[11]  M. Cairo,et al.  Tumour lysis syndrome: new therapeutic strategies and classification , 2004, British journal of haematology.

[12]  A. Lichtin,et al.  Acute leukemia with a very high leukocyte count : Confronting a medical emergency , 2004 .

[13]  C. Patte,et al.  European experience in the treatment of hyperuricemia. , 2001, Seminars in hematology.

[14]  M. Cairo,et al.  A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukemia at high risk for tumor lysis. , 2001, Blood.

[15]  P. Porcu,et al.  Hyperleukocytic Leukemias and Leukostasis: A Review of Pathophysiology, Clinical Presentation and Management , 2000, Leukemia & lymphoma.

[16]  A. T. Harkel,et al.  Topical topic: Alkalinization and the tumor lysis syndrome , 1998 .

[17]  J. Kist-van Holthe,et al.  Alkalinization and the tumor lysis syndrome. , 1998, Medical and pediatric oncology.

[18]  Z. Dreyer,et al.  Renal Venous Thrombosis Complicating Acute Myeloid Leukemia with Hyperleukocytosis , 1996, Journal of pediatric hematology/oncology.

[19]  S. Pai,et al.  Rapid cytoreduction in childhood leukemic hyperleukocytosis by conservative therapy. , 1995, Medical and pediatric oncology.

[20]  J. Kurtzberg,et al.  Management of leukemic hyperleukocytosis with hydration, urinary alkalinization, and allopurinol. Are cranial irradiation and invasive cytoreduction necessary? , 1993, The American journal of pediatric hematology/oncology.

[21]  M. Schell,et al.  Complications and outcome in childhood acute lymphoblastic leukemia with hyperleukocytosis. , 1992, Blood.

[22]  J. M. Rainey.  Oncologic emergencies. , 1982, The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society.