Successful induction therapy for acute myeloid leukemia complicated with brain hemorrhage and hyperleukocytosis

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  • MIYAZAKI Takuya
    Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine
  • ABE Nana
    Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine
  • YAMAZAKI Etsuko
    Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine
  • KOYAMA Satoshi
    Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine
  • MIYASHITA Kazuho
    Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine
  • TAKAHASHI Hiroyuki
    Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine
  • NAKAJIMA Yuki
    Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine
  • TACHIBANA Takayoshi
    Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine
  • KAMIJO Aki
    Department of Transfusion and Cell Therapy, Yokohama City University Hospital
  • TOMITA Naoto
    Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine
  • ISHIGASTUBO Yoshiaki
    Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine

Bibliographic Information

Other Title
  • 著明な白血球増多に脳出血を合併したにもかかわらず初期治療が奏効した急性骨髄性白血病
  • 症例報告 第2回日本血液学会関東甲信越地方会 優秀演題 著明な白血球増多に脳出血を合併したにもかかわらず初期治療が奏効した急性骨髄性白血病
  • ショウレイ ホウコク ダイ2カイ ニホン ケツエキ ガッカイ カントウ コウシンエツチホウカイ ユウシュウ エンダイ チョメイ ナ ハッケッキュウ ゾウ タ ニ ノウシュッケツ オ ガッペイ シタ ニ モ カカワラズ ショキ チリョウ ガ ソウコウ シタ キュウセイ コツズイセイ ハッケツビョウ

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Abstract

Adequate management of hyperleukocytosis in patients with acute myeloid leukemia (AML) is essential for the prevention of life-threatening complications related to leukostasis and tumor lysis syndrome, but the optimal therapeutic strategy remains unclear. We report a 15-year-old girl with newly diagnosed AML who had extreme hyperleukocytosis (leukocyte count at diagnosis, 733,000/μl) leading to a brain hemorrhage. She was initially treated with hydroxyurea, but presented with brain hemorrhage due to leukostasis and underwent leukapheresis emergently with intensive care and mechanical ventilation. Full-dose standard induction chemotherapy was initiated after achieving gradual cytoreduction (leukocyte count, 465,000/μl) within five days after the initiation of therapy with hydroxyurea and leukapheresis. These treatments were successful and she experienced no complications. The patient ultimately recovered fully and was discharged with complete remission of AML. Although the effects of hydroxyurea and leukapheresis in the setting of hyperleukocytosis are still controversial, these initial treatments may contribute to successful bridging therapy followed by subsequent induction chemotherapy, especially in AML cases with extreme hyperleukocytosis or life-threatening leukostasis.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 57 (2), 180-185, 2016

    The Japanese Society of Hematology

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