Leukapheresis and low-dose chemotherapy do not reduce early mortality in acute myeloid leukemia hyperleukocytosis: a systematic review and meta-analysis

Leuk Res. 2014 Apr;38(4):460-8. doi: 10.1016/j.leukres.2014.01.004. Epub 2014 Jan 10.

Abstract

The role of leukapheresis and low-dose chemotherapy is unclear in decreasing early mortality in acute myeloid leukemia (AML) patients with hyperleukocytosis. This systematic review was conducted to describe early mortality (deaths during first induction) in patients with AML with an initial white blood count≥100×10(9)L(-1) stratified by the approach to leukapheresis and hydroxyurea/low-dose chemotherapy. Twenty-one studies were included. Weighted mean early deaths rate (20 studies, 1354 patients) was 20.1% (95% confidence interval 15.0-25.1). Neither leukapheresis strategy (p=0.67) nor hydroxyurea/low-dose chemotherapy (p=0.23) influenced the early death rate. Early mortality related to hyperleukocytosis in AML is not influenced by universal or selected use of leukapheresis or hydroxyurea/low-dose chemotherapy.

Keywords: Acute myeloid leukemia; Early deaths; Hydroxyurea; Leukapheresis; Leukostasis.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Dose-Response Relationship, Drug
  • Humans
  • Leukapheresis*
  • Leukemia, Myeloid, Acute / complications
  • Leukemia, Myeloid, Acute / mortality*
  • Leukemia, Myeloid, Acute / therapy*
  • Leukocytosis / complications
  • Leukocytosis / mortality*
  • Leukocytosis / therapy*
  • Survival Analysis
  • Time Factors
  • Treatment Outcome