Early complications in children with acute lymphoblastic leukemia presenting with hyperleukocytosis
Early complications in children with acute lymphoblastic leukemia presenting with hyperleukocytosis
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DOI：
10.1002/pbc.20178
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发表时间：
2005-07-01
影响因子：
3.2
通讯作者：
Sandlund, JT
中科院分区：
文献类型：
--
作者：
Lowe, EJ;Pui, CH;Sandlund, JT
背景儿童急性淋巴细胞白血病（ALL）伴高白细胞血症的最佳治疗尚不清楚，主要是因为白血病相关并发症的风险特征不明确。Procedure.我们回顾了在圣裘德儿童研究医院就诊的所有既往未经治疗的ALL和初始白细胞计数> 200 x 10（9）/L的儿童的表现特征、初始治疗、并发症的频率和类型。结果共有178名儿童（占所有ALL儿童的80%）初始白细胞计数> 200 x 10（9）/L; 67名患者白细胞计数> 400 x 10（9）/L。16名患者（9%）出现神经系统并发症，其中12名患者在就诊时出现症状。4例患者（2%），初始白细胞计数均> 400 × 10（9）/L，发生CNS出血。11例患者（6%）发生肺白细胞淤滞。高白细胞增多的程度显著预测神经系统（P=0.006）和呼吸系统（P=0.014）并发症。大多数并发症发生在就诊时。细胞减灭术（94例患者）降低了白细胞计数，但延迟了化疗的开始（P=0.013）。结论.严重的白血病相关并发症在儿童ALL中相对少见，大多数发生在就诊时。其发生率与白细胞计数成比例增加。一个大的子集的情况下，可以成功地管理没有cytoreduction。对于白细胞计数> 400 x 10（9）/L的患者或就诊时有并发症的患者，可考虑行减细胞术。(c)2004威利-利斯公司
Background. The optimal management of childhood acute lymphoblastic leukemia (ALL) with hyperleukocytosis is unclear, largely because the risk of leukostasis-related complications is poorly characterized. Procedure. We reviewed the presenting characteristics, initial management, and frequency and type of complications in all children seen at St. Jude Children's Research Hospital with previously untreated ALL and an initial leukocyte Count > 200 x 10(9)/L. Results. A total of 178 children, representing 80% of all children with ALL, had an initial leukocyte Count > 200 x 10(9)/L; 67 patients had a leukocyte Count > 400 x 10(9)/L. Sixteen patients (9%) had neurological complications with 12 of these patients experiencing symptoms at presentation. Four patients (2%), all with initial leukocyte Counts > 400 x 10(9)/L, Suffered a CNS hemorrhage. Pulmonary leukostasis occurred in 11 patients (6%). The degree of hyperleukocytosis was significantly predictive of neurological (P=0.006) and respiratory (P=0.014) complications. The majority of complications occurred at presentation. Cytoreduction (94 patients) decreased the leukocyte count but delayed initiation of chemotherapy (P=0.013). Conclusions. Serious leukostasis-related complications are relatively uncommon in childhood ALL and Most Occur at presentation. Their incidence increases in proportion to the leukocyte Count. A large subset of cases can be managed successfully without cytoreduction. Cytoreduction may be considered for patients with leukocyte Counts > 400 x 10(9)/L or patients who have complications at presentation. (c) 2004 Wiley-Liss, Inc.