Therapeutic Leukapheresis in Pediatric Leukemia: The Cook Children’s Experience




Thapa, Namisha
Cole, Charles
Ray, Anish
Bowman, W. Paul


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Purpose (a): In Pediatrics, acute leukemia is the most common cause of hyperleukocytosis, as defined by WBC above 100K. In children, hyperleukocytosis is associated with early morbidity and mortality due to leukastasis-related complications such as intracranial hemorrhage and pulmonary distress. Additionally, tumor lysis syndrome, a dreaded complication due to high rate of cell turnover, can especially occur if chemotherapy is initiated without leukoreduction. Currently, therapeutic leukapheresis (LK) serves as an adjunctive therapy for select population presenting with hyperleukocytosis and/or leukastasis-related symptoms. Although LK is commonly used for this purpose, specific guidelines regarding when to use LK are not well-established. The purpose of this study is to evaluate the efficacy of LK and to determine the specific patient population that will benefit the most from this procedure. To our knowledge, this is the largest study conducted on efficacy of LK and its clinical outcome in pediatric leukemia patients. Methods (b): After obtaining institutional IRB approval, a retrospective chart review was conducted on 20 pediatric leukemia patients (14 ALL, 5 AML, and 1 CML) who underwent LK at Cook Children’s Medical Center from 2000 to 2014. Data on white blood cell count (WBC), platelets, chemistry, complications due to leukastasis at presentation, complete remission (CR), and overall survival rate were collected. Results (c): At presentation, 15% children had CNS symptoms, 15% had respiratory symptoms, and 5% had both. First round of LK showed 61.6% reduction in WBC from median value of 474.2 (233 – 910 x 109/L) to 182.5 (99.2 – 845 x 109/L). Six patients underwent second LK that reduced WBC by another 28.9% with a final median WBC of 139.35 (27.1 – 725 x 109/L). Overall, 19 out of 20 patients were alive immediately post LK, and 15 patients achieved complete remission. Conclusions (d): LK significantly reduces WBC in pediatric leukemia in patients as young as 22 day old presenting with WBC > 250 9/L; 250 9/L and leukastasis-related complications. LK procedure itself has no significant complications and is concluded to be a safe adjunctive procedure in pediatric leukemia prior to initiation of induction chemotherapy.