Contributions
Abstract: PB1745
Type: Publication Only
Background
Age and cytogenetic/mutational leukemia cell profile are the most important determining factors for long-term survival after therapy in acute myeloid leukemia (AML), whereas the adverse factor elevated white blood cell count (WBC) at diagnosis is often linked to high early mortality.
Aims
Assessment of early mortality
Methods
In a community hospital covering a population of 255000, 67 out of 116 adult patients with newly diagnosed non-APL AML received combination chemotherapy aiming at complete remission (CR) during the time period 2007 - 2016. We assessed 30-day mortality in the subgroups with WBC 51-100x10E9/l (N=5, 8%) and > 100x10E9/l (N=7, 10%, range 126-402x10E9/l), respectively, at diagnosis.
Results
No early deaths were observed in the WBC 50-100 group. In contrast, 2 out of 7 with WBC >100 died day 16 (WBC 126, liver failure) and day 18 (WBC 312, septicemia), respectively. Remarkably, two of the 7 patients with WBC>100 including a 28-year old male with a spectacular WBC 402x10E9/l, are among the long term survivors at 42+ mo and 90+ mo.
Conclusion
Leukocytosis > 50,000 is not defining for early mortality (in the first 30 days) in non-APL AML. Extreme leukocytosis (WBC > 100) does not affect survival if applied with a therapeutic strategy with a curating but protective purpose to avoid acute complications of treatment (such as leukostasis, progressive disseminated intravascular coagulation or acute tumor lysis syndrome). We discuss strategies to avoid complications such as the late insertion of the central venous catheter or another cytostatic sequence during induction for AML with extreme leukocytosis. This strategy replaces leukopheresis that was previously recommended for these cases and allows for an effective and rapid reduction in leukemic tumor mass.
Session topic: 4. Acute myeloid leukemia - Clinical
Keyword(s): Acute Myeloid Leukemia, Hyperleukocytosis, Mortality
Abstract: PB1745
Type: Publication Only
Background
Age and cytogenetic/mutational leukemia cell profile are the most important determining factors for long-term survival after therapy in acute myeloid leukemia (AML), whereas the adverse factor elevated white blood cell count (WBC) at diagnosis is often linked to high early mortality.
Aims
Assessment of early mortality
Methods
In a community hospital covering a population of 255000, 67 out of 116 adult patients with newly diagnosed non-APL AML received combination chemotherapy aiming at complete remission (CR) during the time period 2007 - 2016. We assessed 30-day mortality in the subgroups with WBC 51-100x10E9/l (N=5, 8%) and > 100x10E9/l (N=7, 10%, range 126-402x10E9/l), respectively, at diagnosis.
Results
No early deaths were observed in the WBC 50-100 group. In contrast, 2 out of 7 with WBC >100 died day 16 (WBC 126, liver failure) and day 18 (WBC 312, septicemia), respectively. Remarkably, two of the 7 patients with WBC>100 including a 28-year old male with a spectacular WBC 402x10E9/l, are among the long term survivors at 42+ mo and 90+ mo.
Conclusion
Leukocytosis > 50,000 is not defining for early mortality (in the first 30 days) in non-APL AML. Extreme leukocytosis (WBC > 100) does not affect survival if applied with a therapeutic strategy with a curating but protective purpose to avoid acute complications of treatment (such as leukostasis, progressive disseminated intravascular coagulation or acute tumor lysis syndrome). We discuss strategies to avoid complications such as the late insertion of the central venous catheter or another cytostatic sequence during induction for AML with extreme leukocytosis. This strategy replaces leukopheresis that was previously recommended for these cases and allows for an effective and rapid reduction in leukemic tumor mass.
Session topic: 4. Acute myeloid leukemia - Clinical
Keyword(s): Acute Myeloid Leukemia, Hyperleukocytosis, Mortality