Hyperleucocytosis in Acute Myeloid Leukemia

1.  Both hyperleukocytosis and leucostasis is a/w increased mortality in AML patients
 Greater risk in Patients with leucostatic symptoms
 Stahl et al (Leukemia, 2020):
• Retrospective multicentric study (N=779) of AML with WBC ≥ 50000/cmm-
• 27% had Leucostatic symptoms , 20% required ICU admission, 11% underwent
haemodialysis, 14% required mechanical ventilation
• 30-day mortality 16.7%, 2yr, 3yr and 5yr OS : 35, 31 and 28%
• Compared with asymptomatic hyperleukocytosis, pts with leucostasis had inferior
median OS (7.4 Vs 15.1 months) and inferior 30-day mortality (OR-3.59, p<0.001)

3.  Limited data on hyperleukocytosis adult ALL patients.
 Eguiguren et al. (Blood 1992):
• 64/358 pts enrolled in St Jude Total Therapy Study XI had hyperleucocyctosis
• Estimated 4yrs EFS was inferior pts with hyperleukocytosis (52%Vs 79% ,
p<0.0001).
 Lowe et al. (Pediatr Blood Cancdr 2005):
• 8% (178) ALL pts had WBC >200x109/L
• 9% (16) of them had neurological complications
• 4 (2%) pts with initial leucocyte >400x199/L suffered from CNS haemorrhage
• 11 pts (6%) had pulmonary leucostasis
• Degree of hyperleucostasis was significantly predictive of neurological and
respiratory complications.