| Autor: |
Zeller B; Department of Pediatric Hematology-Oncology, Oslo University Hospital, Oslo. bzeller@ous-hf.no., Arad-Cohen N; Department of Pediatric Hemato-Oncology, Rambam Health Care Campus, Haifa., Cheuk D; Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital and Hong Kong Pediatric Hematology and Oncology Study Group (HKPHOSG), Hong Kong., De Moerloose B; Department of Pediatric Hematology-Oncology, Ghent University Hospital, Gent., Navarro JMF; Department of Pediatric Hemato-Oncology, Hospital Universitario y Politecnico La Fe, Valencia., Hasle H; Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus., Jahnukainen K; New Children's hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Juul-Dam KL; Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus., Kaspers G; Princess Maxima Center for Pediatric Oncology, Utrecht, and Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam., Kovalova Z; Department of Pediatric Oncology/Hematology, Children's Clinical University Hospital, Riga, Latvia., Jonsson OG; Department of Pediatrics, Landspitali University Hospital, Reykjavik, Iceland., Lausen B; Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen., Munthe-Kaas M; Department of Pediatric Hematology-Oncology, Oslo University Hospital, Oslo., Nystrom UN; Department of Clinical Sciences, Pediatrics, Umea University, Umea., Palle J; Department of Women's and Children's Health, Uppsala University, Uppsala., Pasauliene R; Center of Oncology and Hematology, BMT Unit, Vilnius University Children's Hospital, Vilnius, Lithuania., Pronk CJ; Childhood Cancer Center, Skane University Hospital, Lund., Saks K; Department of Pediatrics, SA Tallinna Lastehaigla, Tallinn, Estonia., Tierens A; Laboratory Medicine Program, Hematopathology, University Health Network, Toronto, ON, Canada., Abrahamsson J; Institution for Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg. |
| Abstrakt: |
Hyperleukocytosis in pediatric acute myeloid leukemia (AML) is associated with severe complications and an inferior outcome. We report results on patients with hyperleukocytosis included in the NOPHO-DBH AML 2012 study. We recommended immediate initiation of full-dose chemotherapy (etoposide monotherapy for 5 days as part of the first course), avoiding leukapheresis and prephase chemotherapy. Of 714 patients included in the NOPHO-DBH AML 2012 study, 122 (17.1%) had hyperleukocytosis, and 111 were treated according to the recommendations with etoposide upfront without preceding leukapheresis or prephase chemotherapy. The first dose was applied the same day as the AML diagnosis or the day after in 94%. Etoposide was administered via peripheral veins in 37% of patients without major complications. After initiation of etoposide the white blood cell counts on days 2-5 were 69%, 36%, 17% and 8%, respectively, of the pre-treatment level. On day 3, 81% of patients had a white blood cell count <100 x109/L. Five-year event-free and overall survival rates for all patients with hyperleukocytosis were 52.9% (95% confidence interval [95% CI]: 44.4-63.0) and 74.1% (95% CI: 66.4-82.6), compared to 64.9% (95% CI: 60.9-69.1) and 78.9% (95% CI: 75.4-82.4) for patients without hyperleukocytosis (P<0.001 for event-free survival, P=0.1 overall survival). Six-week early mortality was 4.1% for all patients with hyperleukocytosis (2.7% for the 111 patients treated with etoposide upfront). We conclude that management of hyperleukocytosis in pediatric AML with immediate etoposide monotherapy without leukapheresis or prephase chemotherapy is feasible, safe and effective. The reduction in white blood cell count during the first days is comparable to the reported results of leukapheresis, and outcomes seem at least equivalent to therapies including leukapheresis. Based on our results, we advocate abandoning leukapheresis for hyperleukocytosis in pediatric AML. Instead, it is crucial to start induction chemotherapy as early as possible. |
