Exchange Transfusion and Leukapheresis in Pediatric Patients with AML With High Risk of Early Death by Bleeding and Leukostasis
Abstrakt
BackgroundThe risk of early death (ED) by bleeding/leukostasis is high in patients with AML with hyperleukocytosis (>100,000/l). Within the pediatric AML-BFM (Berlin-Frankfurt-Munster) 98/04 studies, emergency strategies for these children included exchange transfusion (ET) or leukapheresis (LPh).
Risk factors for ED and interventions performed were analyzed. PatientsTwo hundred thirty-eight of 1,251 (19%) patients with AML presented with hyperleukocytosis; 23 of 1,251 (1.8%) patients died of bleeding/leukostasis.
ResultsED due to bleeding/leukostasis was highest at white blood cell (WBC) count >200,000/l (14.3%). ED rates were even higher (20%) in patients with FAB (French-American-British) M4/M5 and hyperleukocytosis >200,000/l.
Patients with WBC >200,000/l did slightly better with ET/LPh compared to those without ET/LPh (ED rate 7.5% vs. 21.2%, P = 0.055). Multivariate WBC >200,000/l was of strongest prognostic significance for ED (P((2)) 200,000/l, and in FAB M4/M5 even at lower WBC.