Treatment in adult patients with acute myeloid leukemias with hyperleukocytosis at disease onset


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Aim. To evaluate the efficiency of the treatment policy for patients with acute myeloid leukemia (AML) and hyperleukocytosis (HL), which is aimed at preventing rapid hypercytolysis and massive tumor lysis (cytolysis) syndrome and/or at reducing the degree of the latter at the start of induction polychemotherapy. Subjects and methods. In 2010 to 2014, the Hematology Research Center, Ministry of Health of Russia, treated 92 patients with AML, out of them 18 patients were found to have white blood cell counts of 100 to 408∙109/l (median, 130∙109/l) at the onset of the disease. All the examinees received cytoreductive therapy with hydroxyurea and, in presence of leukostasis and/or leukocytosis (≥150∙109/l), with leukocytapheresis. In case of reduced leukocytosis, plasmapheresis was carried out to prevent (treat) cytolysis. Daunorubicin was injected on days 3—5 of the 7+3 induction cycle. Results. The signs of leukostases were detected in more than half of the 18 patients with higher white blood cell counts: 13 (72%) with lung injury, including 5 of them with signs of respiratory distress syndrome, 6 (27.8%) with neurological symptomatology, 7 (38.9%) with disseminated intravascular coagulation syndrome, including 1 with intracranial hemorrhage. Cytoreduction therapy with hydroxyurea (10 mg/kg/day) was performed 1—5 (median 2) days before initiating induction chemotherapy in 17 patients; 9 patients underwent 1—2 (median 2) leukocytapheresis sessions. Sixteen patients received 1—4 (median 2) plasmapheresis sessions prior to and within the first days of the 7+3 treatment regimen. Daunorubicin (60 mg/m2) was administered to 16 patients on days 5—7 of the 7+3 cycle and to 2 patients on days 3—5 of the cycle. There were no signs of severe cytolysis with the development of multiple organ dysfunction in any patient. 50% (9/18) achieved remission after the first 7+3 cycle and 7 more examinees did after the second cycle. Thus, the remission rate was 89%; early mortality was 5.5% (1/18), three-year overall and relapse-free survival rates were 50%. Conclusion. Adequate cytoreductive and accompanying therapies for AML with HL can virtually completely prevent massive tumor cytolysis syndrome and early mortality during the first days of induction chemotherapy.

References

  1. Porcu P, Farag S, Marcucci G, Cataland SR, Kennedy MS, Bissell M. Leukocytoreduction for Acute Leukemia. Ther Apher. 2002;6(1):15-23. doi: 10.1046/j.1526-0968.2002.00402.x.
  2. Marbello L, Ricci F, Nosari AM, Turrini M, Nador G, Nichelatti M, Tedeschi A, Vismara E, Morra E. Outcome of hyperleukocytic adult acute myeloid leukaemia: A single-center retrospective study and review of literature. Leuk Res. 2008;32(8):1221-1227. doi: 10.1016/j.leukres.2008.01.004. epub 2008 mar 3.
  3. Canzel С, Becker J, Mintz PD, Lazarus HM, Rowe JM. Hyperleukocytosis, leukostasis and leukapheresis: practice management. Blood Rev. 2012;26(3):117-122. doi: 10.1016/j.blre.2012.01.003. epub 2012 feb 23.
  4. Галстян Г.М. Сочетанное проведение химиотерапии гемобластозов и терапии острой дыхательной недостаточности в реанимационных условиях. Терапевтический архив. 2009;12: 37-43.
  5. Cairo MS., Bishop M. Tumor lysis syndrome: new therapeutic strategies and classification. Br J of Haematol. 2004;127(1):3-11. doi: 10.1111/j.1365-2141.2004.05094.x.
  6. Holig K, Moog R. Leukocyte depletion by therapeutic leukocytapheresis in patients with leukemia. Transfus Med Hemother. 2012;39:241-245. doi: 10.1159/000341805.
  7. Giles FJ, Shen Y, Kantarjian HM, Korbling MJ, O’Brien S, Anderlini P, Donato M, Pierce S, Keating, Freireich EJ, Estey E. Leukapheresis reduces early mortality in patients with acute myeloid leukemia with high white cell counts but does not improve long-term survival. Leuk Lymphoma. 2001;42:67-73. doi: 10.3109/10428190109097677.
  8. Thiébaut A, Thomas X, Belhabri A, Anglaret B, Archimbaud E. Impact of pre-induction therapy leukapheresis on treatment outcome in adult acute myelogenous leukemia presenting with hyperleukocytosis. Ann Hematol. 2000;79:501-506. doi: 10.1007/s002770000162.
  9. Szczepiorkowski ZM, Winters JL, Bandarenco N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwartz J, Weinstein R, Shaz BH. Guidelines on the use of therapeutic apheresis in clinical practice — evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher. 2010;25:83-177. doi: 10.1002/jca.20240.
  10. Шатров В.А. Лечебный плазма- и цитаферез в терапии лейкозов: Автореф. дис. ... канд. мед. наук. Л.; 1984.
  11. Bruserud O, Liseth K, Stamnesfet S et al. Hyperleukocytosis and leukocytapheresis in acute leukaemias: experience from a single centre and review of the literature of leukocytapheresis in acute myeloid leukaemia. Transfus Med. 2013, Aug 6. doi:10/1111/tme. 12067.
  12. Савченко В.Г., Паровичникова Е.Н. Лечение острых лейкозов. М.: МЕДпресс-информ; 2004;14-49.
  13. Соколов А.Н., Паровичникова Е.Н., Куликов С.М., Клясова Г.А., Троицкая В.В., Кохно А.В., Анчукова Л.В., Фролова М.В., Капланов К.Д., Константинова Т.С., Капорская Т.С., Загоскина Т.П., Москов В.И., Домникова Н.П., Приступа А.С., Гаврилова Л.В., Свиридова Е.И., Лапин В.А., Ротанова М.Н., Савченко В.Г. Долгосрочные результаты лечения острых миелоидных лейкозов у взрослых в многоцентровом клиническом исследовании ОМЛ 06.06. Клиническая онкогематология. 2012;5(1):30-38.
  14. Троицкая В.В., Паровичникова Е.Н., Соколов А.Н., Кузьмина Л.А., Бадмажапова Д.С., Парамонова Е.В., Гапонова Т.В., Кравченко С.К., Савченко В.Г. Особенности индукционной терапии больных с гиперлейкоцитозом в дебюте острого миелобластного лейкоза. Гематология и трансфузиология. 2014;59(1, прил. 1):124.
  15. Troitskaya V, Parovichnikova E, Sokolov A, Kuzmina L, Kliasova G., Badmazhapova D, Paramonova E, Savchenko V. Induction therapy in patients with acute myeloid leukemia presenting with hyperleukocytosis. Haematologica. 2014;99(Suppl. 1, PB1460): 568-569.
  16. Паровичникова Е.Н., Клясова Г.А., Соколов А.Н.,Троицкая В.В., Кохно А.В, Кузьмина Л.А., Шафоростова И.И. Рыжко В.В., Кравченко С.К., Бондаренко С.Н., Лапин В.А., Приступа А.С., Константинова Т.С., Загоскина Т.П., Ялыкомов И.В., Москов В.И., Анчукова Л.В., Капорская Т.С., Володичева Е.М., Капланов К.Д., Кондаков Е.В., Самойлова О.С., Гаврилова Л.В., Куликов С.М., Савченко В.Г. Первые результаты лечения острых миелоидных лейкозов взрослых по протоколу ОМЛ-01.10 Научно-исследовательской группой центров России. Терапевтический архив. 2012;7:10-15.
  17. Паровичникова Е.Н., Исаев В.Г. Протокол выполнения индукционной фазы лечения у больных острыми лейкозами, протекающими с гиперлейкоцитозом. В кн.: Программное лечение лейкозов: Сборник протоколов и алгоритмов химиотерапии и сопроводительного лечения лейкозов, миелодисплазий и аплазий кроветворения. Т. I. Под ред. Савченко В.Г. М.: ГНЦ РАМН; 2008.
  18. Савченко В.Г., Паровичникова Е.Н., Афанасьев Б.В., Грицаев С.В., Семочкин С.В., Бондаренко С.Н., Троицкая В.В., Соколов А.Н., Кузьмина Л.А., Клясова Г.А., Баранова О.Ю., Лапин В.А., Константинова Т.С., Самойлова О.С., Капорская Т.С., Шатохин С.В. Клинические рекомендации российских экспертов по лечению больных острыми миелоидными лейкозами в возрасте моложе 60 лет. Терапевтический архив. 2014;7:4-13.
  19. Паровичникова Е.Н., Троицкая В.В., Клясова Г.А., Кузьмина Л.А., Соколов А.Н., Парамонова Е.В., Галстян Г.М., Кессельман С.А., Дроков М.Ю., Васильева В.А., Обухова Т.Н., Куликов С.М., Савченко В.Г. Лечение больных острыми миелоидными лейкозами по протоколу российского многоцентрового рандомизированного исследования ОМЛ-01.10: результаты координационного центра. Терапевтический архив. 2014;7:14-23.
  20. Парамонова Е.В., Паровичникова Е.Н., Троицкая В.В., Соколов А.Н., Кузьмина Л.А., Клясова Г.А., Галстян Г.М., Обухова Т.Н., Савченко В.Г. Результаты лечения острых миелоидных лейкозов (ОМЛ) в ГНЦ МЗ РФ по протоколу ОМЛ-01.10. Гематология и трансфузиология. 2014;59(1, прил. 1):57-58.
  21. Barret CL, Louw VJ, Webb MJ. Exchange transfusion as a life-saving intervention in three patients with different haematological malignancies with severe hyperleukocytosis where leukaferesis was not available. Transfusion and Apheresis Science. 2013;49:397-402. doi: 10.1016/j.transci.2013.09.003.
  22. Wang CW, Lin KH, Lin YP, Chein CH, Li PJ, Ko LY. Blood exchange transfusion as an emergency treatment for hyperleukocytosis in leukemia: report of one case. [Article in Chinese] Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1991;32(6):387-390.
  23. Паровичникова Е.Н., Клясова Г.А., Соколов А.Н., Куликов С.М, Савченко В.Г. Клинический протокол ОМЛ-01.10 по лечению острых миелоидных лейкозов взрослых. В кн.: Программное лечение заболеваний системы крови. Под ред. Савченко В.Г. М.: Практика; 2012:153-206.
  24. Паровичникова Е.Н., Соколов А.Н., Клясова Г.А., Савченко В.Г. Унифицированный протокол лечения больных ОМЛ в возрасте моложе 60 лет. В кн.: Программное лечение заболеваний системы крови. Под ред. Савченко В.Г. М.: Практика; 2012:207-233.
  25. Lester TJ, Johnson JW, Cuttner J. Pulmonary leukostasis as the single worst prognostic factor in patients with acute myelocytic leukemia and hyperleukocytosis. Am J Med. 1985;79:43-48. doi: 10.1016/0002-9343(85)90544-3.
  26. Pastore F, Pastore A, Wittmann G., Hiddeman W., Spiekerman K. The role of therapeutic leukapheresis in hyperleukocytotic AML. PloS ONE. 2014;9(4):e95062. doi: 10.1371/journal.pone.0095062.
  27. Bruserud O, Liseth K, Stamnesfet S et al. Hyperleukocytosis and leukocytapheresis in acute leukaemias: experience from a single centre and review of the literature of leukocytapheresis in acute myeloid leukaemia. Transfus Med. 2013, Aug 6. doi:10/1111/tme. 12067.
  28. Oberoi S, Lehrnbecher T, Phillips B, Hitzler J, Ethier MC, Beyene J, Sung L. Leukapheresis and low-dose chemotherapy do not reduce early mortality in acute myeloid leukemia hyperleukocytosis: a systematic review and meta-analysis. Leuk Res. 2014;38(4): 460-468. doi: 10.1016/j.leukres.2014.01.004.

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