PMID- 34054042
OWN - NLM
STAT- MEDLINE
DCOM- 20220215
LR  - 20231002
IS  - 1536-3678 (Electronic)
IS  - 1077-4114 (Linking)
VI  - 44
IP  - 1
DP  - 2022 Jan 1
TI  - Management of Hyperleukocytosis in Childhood Acute Leukemia Without Leukapheresis 
      and Rasburicase Prophylaxis.
PG  - 12-18
LID - 10.1097/MPH.0000000000002225 [doi]
AB  - Indications of leukapheresis (LPh) and the prophylactic use of rasburicase in 
      tumor lysis syndrome (TLS) of patients with acute leukemia with hyperleukocytosis 
      are not clear. In this retrospective single-center pediatric study, the outcomes 
      of patients with hyperleukocytosis were reviewed. There were 48 patients with 
      acute lymphoblastic leukemia (ALL) and 13 patients with acute myeloblastic 
      leukemia (AML). The treatment strategies included hyperhydration, allopurinol 
      administration, strict monitoring, and early initiation of induction chemotherapy 
      (CT). No patient underwent LPh because it was not available. Rasburicase was used 
      only in 3 ALL patients with hyperuricemia when the drug was available. Laboratory 
      and clinical TLS developed in 54.16% and 14.58% of patients with ALL, 
      respectively. Laboratory and clinical TLS developed in 76.92% and 15.38% of 
      patients with AML, respectively. No patient developed grade III to V TLS 
      requiring dialysis. Thirteen patients (21.3%) had pulmonary leukostasis on 
      admission, but recovered with CT and nasal oxygen. During the first 14 days of 
      presentation, cerebral leukostasis/coagulopathy-related early death (ED) was 4.2% 
      and 7.7% in patients with ALL and AML, respectively, and all of these patients 
      had a white blood cell count >/=400,000/microL. There was also 1 infection-related 
      death. Patients with hyperleukocytosis can be treated without LPh and liberal use 
      of rasburicase. Renal failure is no longer a cause of ED. Intracranial hemorrhage 
      is the main cause of ED, especially in patients already presenting with this 
      complication. LPh may be performed in patients with leukostasis, if it is not 
      possible to start induction CT early. When resources are limited, rasburicase 
      should be administered in patients presenting with or developing hyperuricemia 
      and/or renal dysfunction.
CI  - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Aylan Gelen, Sema
AU  - Aylan Gelen S
AD  - Department of Pediatrics, Division of Pediatric Hematology, Kocaeli University, 
      Kocaeli, Turkey.
FAU - Sarper, Nazan
AU  - Sarper N
FAU - Zengin, Emine
AU  - Zengin E
FAU - Azizoglu, Mehmet
AU  - Azizoglu M
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Pediatr Hematol Oncol
JT  - Journal of pediatric hematology/oncology
JID - 9505928
RN  - 08GY9K1EUO (rasburicase)
RN  - EC 1.7.3.3 (Urate Oxidase)
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - *Induction Chemotherapy
MH  - Infant
MH  - Infant, Newborn
MH  - Leukapheresis
MH  - Leukemia, Myeloid, Acute/*drug therapy
MH  - Leukocytosis/etiology/*prevention & control
MH  - Male
MH  - Precursor Cell Lymphoblastic Leukemia-Lymphoma/*drug therapy
MH  - Retrospective Studies
MH  - Urate Oxidase/*administration & dosage
COIS- The authors declare no conflict of interest.
EDAT- 2021/06/01 06:00
MHDA- 2022/02/16 06:00
CRDT- 2021/05/31 05:57
PHST- 2020/07/27 00:00 [received]
PHST- 2021/05/04 00:00 [accepted]
PHST- 2021/06/01 06:00 [pubmed]
PHST- 2022/02/16 06:00 [medline]
PHST- 2021/05/31 05:57 [entrez]
AID - 00043426-202201000-00002 [pii]
AID - 10.1097/MPH.0000000000002225 [doi]
PST - ppublish
SO  - J Pediatr Hematol Oncol. 2022 Jan 1;44(1):12-18. doi: 
      10.1097/MPH.0000000000002225.