TY - JOUR
T1 - Management of hyperleukocytosis in pediatric acute myeloid leukemia using immediate chemotherapy without leukapheresis
T2 - results from the NOPHO-DBH AML 2012 Protocol
AU - Zeller, Bernward
AU - Arad-Cohen, Nira
AU - Cheuk, Daniel
AU - De Moerloose, Barbara
AU - Navarro, Jose M Fernandez
AU - Hasle, Henrik
AU - Jahnukainen, Kirsi
AU - Juul-Dam, Kristian Lovvik
AU - Kaspers, Gertjan
AU - Kovalova, Zanna
AU - Jonsson, Olafur G
AU - Lausen, Birgitte
AU - Munthe-Kaas, Monica
AU - Nystrom, Ulrika Noren
AU - Palle, Josefine
AU - Pasauliene, Ramune
AU - Pronk, Cornelis J
AU - Saks, Kadri
AU - Tierens, Anne
AU - Abrahamsson, Jonas
PY - 2024/9/1
Y1 - 2024/9/1
N2 - Hyperleukocytosis in pediatric acute myeloid leukemia (AML) is associated with severe complications and an inferior outcome. We report results on patients with hyperleukocytosis included in the NOPHO-DBH AML 2012 study. We recommended immediate initiation of full-dose chemotherapy (etoposide monotherapy for 5 days as part of the first course), avoiding leukapheresis and prephase chemotherapy. Of 714 patients included in the NOPHO-DBH AML 2012 study, 122 (17.1%) had hyperleukocytosis, and 111 were treated according to the recommendations with etoposide upfront without preceding leukapheresis or prephase chemotherapy. The first dose was applied the same day as the AML diagnosis or the day after in 94%. Etoposide was administered via peripheral veins in 37% of patients without major complications. After initiation of etoposide the white blood cell counts on days 2-5 were 69%, 36%, 17% and 8%, respectively, of the pre-treatment level. On day 3, 81% of patients had a white blood cell count <100 x109/L. Five-year event-free and overall survival rates for all patients with hyperleukocytosis were 52.9% (95% confidence interval [95% CI]: 44.4-63.0) and 74.1% (95% CI: 66.4-82.6), compared to 64.9% (95% CI: 60.9-69.1) and 78.9% (95% CI: 75.4-82.4) for patients without hyperleukocytosis (P<0.001 for event-free survival, P=0.1 overall survival). Six-week early mortality was 4.1% for all patients with hyperleukocytosis (2.7% for the 111 patients treated with etoposide upfront). We conclude that management of hyperleukocytosis in pediatric AML with immediate etoposide monotherapy without leukapheresis or prephase chemotherapy is feasible, safe and effective. The reduction in white blood cell count during the first days is comparable to the reported results of leukapheresis, and outcomes seem at least equivalent to therapies including leukapheresis. Based on our results, we advocate abandoning leukapheresis for hyperleukocytosis in pediatric AML. Instead, it is crucial to start induction chemotherapy as early as possible.
AB - Hyperleukocytosis in pediatric acute myeloid leukemia (AML) is associated with severe complications and an inferior outcome. We report results on patients with hyperleukocytosis included in the NOPHO-DBH AML 2012 study. We recommended immediate initiation of full-dose chemotherapy (etoposide monotherapy for 5 days as part of the first course), avoiding leukapheresis and prephase chemotherapy. Of 714 patients included in the NOPHO-DBH AML 2012 study, 122 (17.1%) had hyperleukocytosis, and 111 were treated according to the recommendations with etoposide upfront without preceding leukapheresis or prephase chemotherapy. The first dose was applied the same day as the AML diagnosis or the day after in 94%. Etoposide was administered via peripheral veins in 37% of patients without major complications. After initiation of etoposide the white blood cell counts on days 2-5 were 69%, 36%, 17% and 8%, respectively, of the pre-treatment level. On day 3, 81% of patients had a white blood cell count <100 x109/L. Five-year event-free and overall survival rates for all patients with hyperleukocytosis were 52.9% (95% confidence interval [95% CI]: 44.4-63.0) and 74.1% (95% CI: 66.4-82.6), compared to 64.9% (95% CI: 60.9-69.1) and 78.9% (95% CI: 75.4-82.4) for patients without hyperleukocytosis (P<0.001 for event-free survival, P=0.1 overall survival). Six-week early mortality was 4.1% for all patients with hyperleukocytosis (2.7% for the 111 patients treated with etoposide upfront). We conclude that management of hyperleukocytosis in pediatric AML with immediate etoposide monotherapy without leukapheresis or prephase chemotherapy is feasible, safe and effective. The reduction in white blood cell count during the first days is comparable to the reported results of leukapheresis, and outcomes seem at least equivalent to therapies including leukapheresis. Based on our results, we advocate abandoning leukapheresis for hyperleukocytosis in pediatric AML. Instead, it is crucial to start induction chemotherapy as early as possible.
KW - Adolescent
KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
KW - Child
KW - Child, Preschool
KW - Disease Management
KW - Etoposide/administration & dosage
KW - Female
KW - Humans
KW - Infant
KW - Leukapheresis
KW - Leukemia, Myeloid, Acute/therapy
KW - Leukocyte Count
KW - Leukocytosis/therapy
KW - Male
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85203029631&partnerID=8YFLogxK
U2 - 10.3324/haematol.2024.285285
DO - 10.3324/haematol.2024.285285
M3 - Journal article
C2 - 38721737
SN - 0390-6078
VL - 109
SP - 2873
EP - 2883
JO - Haematologica
JF - Haematologica
IS - 9
ER -