A STUDY ON EFFECTIVENESS OF LEUKEPHERESIS IN PATIENTS WITH HYPERLEUKOCYTIC LEUKEMIAS

Van Phong Hoang1,, Manh Quan Ngo 2, Ngoc Dung Nguyen 2, Thi Thu Huyen Nguyen 3
1 Center for Hematology - Blood Transfusion, Vietnam - Czech friendship hospital
2 National Institute of Hematology - Blood Transfusion
3 Internal medical department, Vietnam - Czech friendship hospital

Nội dung chính của bài viết

Tóm tắt

Background: Thrombosis is a common complication of hyperleukocytic leukemias. Purpose: To access features of leukostasis, effectiveness of leukopheresis in terms of reduction of WBC, and biochemistry indicators in hyperleukocytic leukemias. Patients and methods: An intervention study was carried out on 112 CML patients treated with leukopheresis in Hai Phong Vietnam - Czech friendship hospital from 7/2017 to 3/2019. Results: (1) Clinical symptoms of leukostatsis: (a) Percentage of symptoms: headache/dizziness: 38,0%; visual impairment/hearing loss: 2,0%; splenic pain/infarct: 12,0%; priapism: 2,0%; leukostasis related pulmonary distress syndrome: 2,0%; CNS hemorrhage: 2,0%. (2) Effectiveness of leukopheresis in term of reduction of WBC, and biochemistry indicators in hyperleukocytic leukemias: (a) WBC reduced significantly after leukopheresis and after 24 hours: CML: 304, 219 and 198 G/l; AML: 295, 206 and 194 G/l; ALL: 342, 207 and 185 G/l, respectively (with P<0,01); (b) Cytoreduction effectiveness after leukopheresis in CML, AML and ALL after 24 hours are: 34,7%; 34,2% and 45,9% respectively. (3) Change of blood uric acid and LDH concentrations after leukopheresis: (a) Uric acid concentration reduced significantly for males and females after leukopheresis; (b) LDH concentration reduced significantly (CML: 3.129 and 1.892 U/l; AML: 2.589 and 1.491 U/l; ALL: 2.992 and 1712 U/l (P<0,01) before and after leukopheresis, respectively (with P<0,01). Conclusion: Leukopheresis is an effective supportive treatment for hyperleukocytic leukamias.

Chi tiết bài viết

Tài liệu tham khảo

1. Committee of the American Society for Apheresis (2007) Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence - based Approach from the Apheresis Applications Committee of the American Society for Apheresis. Journal of Clinical Apheresis 22:131.
2. De Santis GC, et al. (2011) Therapeutic leukapheresis in patients with leukostasis secondary to acute myelogenous leukemia.,Journal of Clinical Apheresis 26: 181-185.
3. Novotny JR, Kribben A (2005) Grading of symptoms in hyperleukocytic leukaemia: a clinical model for the role of different blast types and promyelocytes in the development of leukostasis syndrome. Euopean Journal of Heamatoliogy 74:501-510.
4. Porcu P, Crippe LD, NG EW, et al. (2000) Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation, and management. Leukemia lymphoma 39:1-18.
5. Stucki A, River A (2001), “Endothelial cell activation by myeloblasts: molecular of mechanisms leukostasis and leukemic cell dissemination”, Blood 97(7), pp. 2121-2129.
6. Thiesbaut A, Thomas X, Belhabri A, et al. (2000) Impact of pre-induction therapy leukaphereis on treatment outcome in adult acute myelogenous leukemia presenting with hyperleukocytosis. Annual Hematology 79:501-506.