Exchange Transfusion and Leukapheresis in Pediatric Patients with AML With High Risk of Early Death by Bleeding and Leukostasis

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  • Ursula Creutzig
    Department of Pediatric Hematology and Oncology Children's Hospital Hannover Medical School Hannover Germany
  • Claudia Rössig
    Department of Pediatric Hematology and Oncology University Children's Hospital Muenster Muenster Germany
  • Michael Dworzak
    Department of Pediatrics St. Anna Children's Hospital and Children's Cancer Research Institute Medical University of Vienna Vienna Austria
  • Jan Stary
    Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
  • Arend von Stackelberg
    Department of Pediatric Oncology/Hematology Charité University Medical Center Berlin Berlin Germany
  • Wilhelm Wössmann
    Department of Pediatric Hematology and Oncology Justus‐Liebig‐University Giessen Germany
  • Martin Zimmermann
    Department of Pediatric Hematology and Oncology Children's Hospital Hannover Medical School Hannover Germany
  • Dirk Reinhardt
    Department of Pediatric Hematology‐Oncology University of Duisburg‐Essen Essen Germany

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<jats:sec><jats:title>Background</jats:title><jats:p>The risk of early death (ED) by bleeding/leukostasis is high in patients with AML with hyperleukocytosis (>100,000/μl). Within the pediatric AML‐BFM (Berlin‐Frankfurt‐Münster) 98/04 studies, emergency strategies for these children included exchange transfusion (ET) or leukapheresis (LPh). Risk factors for ED and interventions performed were analyzed.</jats:p></jats:sec><jats:sec><jats:title>Patients</jats:title><jats:p>Two hundred thirty‐eight of 1,251 (19%) patients with AML presented with hyperleukocytosis; 23 of 1,251 (1.8%) patients died of bleeding/leukostasis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>ED due to bleeding/leukostasis was highest at white blood cell (WBC) count >200,000/μl (14.3%). ED rates were even higher (20%) in patients with FAB (French‐American‐British) M4/M5 and hyperleukocytosis >200,000/μl. Patients with WBC >200,000/μl did slightly better with ET/LPh compared to those without ET/LPh (ED rate 7.5% vs. 21.2%, <jats:italic>P</jats:italic> = 0.055). Multivariate WBC >200,000/μl was of strongest prognostic significance for ED (<jats:italic>P</jats:italic>(χ<jats:sup>2</jats:sup>) <0.0001).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Our data confirm the high risk of bleeding/leukostasis in patients with hyperleukocytosis. ET/LPh shows a trend toward reduced ED rate due to bleeding/leukostasis and is recommended at WBC >200,000/μl, and in FAB M4/M5 even at lower WBC.</jats:p></jats:sec>

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