Hiperlökositoz Bulgusu ile Başvuran Akut Myelositer Lösemili Olgularda Lökoferez, Hidroksiüre ve Steroid Tedavilerinin Geriye Dönük Olarak Birbiri ile Karşılaştırılması

Yıl 2020, , 401 - 405, 25.12.2020

Merve Pamukcuoglu , Mehmet Sezgin Pepeler

https://doi.org/10.35440/hutfd.823152

Öz

Amaç: Akut myeloid lösemili olguların bir kısmı lökositoz ve hatta eşlik eden lökositaz bulguları ile başvurmaktadır. Hiperlökositoz ve lökositaz bulguları olan hastalarda indüksiyon tedavisi öncesi sitoredüktif tedavi rutin pratikte uygulanan bir yöntemdir. Bu çalışmada; hiperlökositoz ile başvuran akut myeloid lösemili olgularda hidroksiüre sitoredüksiyon tedavisi ile hidroksiüre/lökoferez/steroid sitoredüksiyon tedavilerinin karşılaştırılması amaçlanmıştır.
Materyal Metod: Çalışmaya hiperlökositoz bulgusu ile başvuran 40 akut myeloid lösemili olgu alınmıştır. Hastaların dosya bilgileri geriye dönük taranmış ve demografik özellikleri ile aldıkları sitoredüktif tedaviler belirlenmiştir. Kırk hastadan 30’una hidroksiüre sitoredüksiyon tedavisi, 10 hastaya ise hidroksiüre/lökoferez/steroid sitoredüksiyon tedavileri verilmiştir.
Bulgular: Hastaların ortanca yaşı 48,5 / yıl (en düşük-en yüksek: 18-75/yıl) idi. Altmış yaş altında 30 (%75) hasta, 60 yaş üstünde 10 (%25) hasta vardı. Yirmibir (% 52,5) hasta erkek, 19 (%47,5) hasta kadın idi. Hastaların başvuru anındaki beyaz küre değerlerinin ortancası 86.x109/L (düşük/yüksek: 50.x109/L -300.x109/L) idi. Sitoredüksiyon tedavisi sonrası hastaların beyaz küre değerinin ortancası 71.x109/L (düşük/yüksek: 38.x109/L -95.x109/L) idi. Tanı anında yapılan kemik iliği aspırasyonundaki blast oranı ortanca %82,75 (düşük/yüksek;%20-%100) idi. Sitoredüksiyon ve birinci indüksiyon sonrası yapılan kontrol kemik iliği aspırasyonundaki blast oranlarının ortancası %5,12 (düşük/yüksek;%0-%100) idi.Hidroksiüre/lökoferez/steroid alan kolda sadece hidroksiüre alan kola göre beyaz küre değerlerinin daha iyi kontrol altına alındığı görüldü (p:0,001). Ancak sitoredüksiyon tedavi kollarından hiçbirinin kemik iliğinde blast oranını azaltması yönünde anlamlı ilişkisi olmadığı tespit edildi (p: >0,05).
Sonuç: Hidroksiüre/ lökoferez/steroid kolunun sadece hidroksiüre koluna göre çevre kanı beyaz küre sayısını daha etkin düşürdüğü sonucuna varılmıştır.

Anahtar Kelimeler

lökositoz, lökositaz, lökoferez, hidroksiüre

A Retrospective Comparison of Leukapheresis, Hydroxyurea and Steroid Therapies in Patients with Acute Myelocytic Leukemia who Present with Hyperleukocytosis

Öz

Background: Some of the cases with acute myeloid leukemia present with hyperleukocytosis and even accompanying leukocytosis. Cytoreductive therapy is a routine practice method in patients with hyperleukocytosis and leukocytosis before induction therapy. In this study; We aimed to compare hydroxyurea cytoreduction treatment with hydroxyurea / leukapheresis / steroid cytoreduction treatments in patients with acute myeloid leukemia presenting with hyperleukocytosis.
Materials and Methods: Forty patients with acute myeloid leukemia who admitted to the study with evidence of hyperleukocytosis were included. Patients' file information was retrospectively scanned and their demographic characteristics and cytoreductive treatments were determined. Hydroxyurea cytoreduction treatment was given to 30 of the forty patients and hydroxyurea / leukapheresis / steroid cytoreduction treatments were given to 10 patients.
Results: The median age of the patients was 48.5 / year (minimum-maximum: 18-75 / year). There were 30 (75%) patients under the age of 60 and 10 (25%) patients above the age of 60. Twenty-one (52.5%) patients were male and 19 (47.5%) patients were female. The median of the patients' white blood cell count at admission was 86x109 / L (low / high: 50x109 / L -300x109 / L). After cytoreduction treatment, the median of the white blood cell count of the patients was 71x109 / L (low / high: 38x109 / L -95x109 / L). The median blast rate in bone marrow aspirate performed at the time of diagnosis was 82.75% (low / high; 20% -100%). The median of blast rates in control bone marrow aspirate performed after cytoreduction and first induction was 5.12% (low / high; 0% -100%). was seen (p= 0.001). However, it was found that none of the cytoreduction treatment arms had a significant relationship in terms of decreasing the blast rate in the bone marrow (p > 0.05).
Conclusion: It was concluded that the hydroxyurea / leukapheresis / steroid arm reduced the peripheral white blood cell count more effectively than the hydroxyurea arm.

Key words: Hyperleukocytosis, Leukocytosis, Leukapheresis, Hydroxyurea

Anahtar Kelimeler

Hyperleukocytosis, leukositasis, leukapheresis, hydroxyurea

Kaynakça

• 1-Dutcher JP, Schiffer CA, Wiernik PH. Hyperleukocytosis in adult acute nonlymphocytic leukemia: impact on remission rate and duration, and survival. J Clin Oncol 1987;5:1364–1372.
• 2-Greenwood MJ, Seftel MD, Richardson C, Barbaric D, Barnett MJ, Bruyere H et al. Leukocyte count as a predictor of death during remission induction in acute myeloid leukemia. Leuk Lymphoma 2006;47:1245–1252.
• 3- Oliveira LC, Romano LG, Prado-Junior BP, Covas DT, Rego EM, De Santis GC. Outcome of acute myeloid leukemia patients with hyperleukocytosis in Brazil. Med Oncol 2010;27:1254–1259.
• 4-Porcu P, Cripe LD, Ng EW, Bhatia S, Danielson CM, Orazi A et al. Hyperleukocytic leukemia and leukostasis: a review of pathophysiology, clinical presentation and management. Leuk Lymphoma 2000;39:1–18.
• 5-Stucki A, Rivier AS, Gikic M, Monai N, Schapira M, Spertini O. Endothelial cell activation by myeloblasts: molecular mechanisms of leukostasis and leukemic cell dissemination. Blood 2001; 97: 2121–2129.
• 6-Stemmler J, Wittmann GW, Hacker U, Heinemann V. Leukapheresis in chronic myelomonocytic leukemia with leukostasis syndrome: elevated serum lactate levels as an early sign of microcirculation failure. Leuk Lymphoma 2002, 43: 1427–1430.
• 7-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.
• 8- Lichtman MA, Rowe JM. Hyperleukocytic leukemias: rheological, clinical, and therapeutic considerations. Blood 1982;60:279–283.
• 9- De Santis GC, de Oliveira LC, Romano LG, Almeida Prado Bde P Jr, Simoes BP, Rego EM et al.Therapeutic leukapheresis in patients with leukostasis secondary to acute myelogenous leukemia. J Clin Apher. 2011;26(4):181-5.
• 10- Schulz M, Bug G, Bialleck H, Serve H, Seifried E, Bönig H. Leucodepletion for hyperleucocytosis--first report on a novel technology featuring electronic interphase management. Vox Sang. 2013 Jul;105(1):47-53.
• 11- Pastore F, Pastore A, Wittmann G, Hiddemann W, Spiekermann K. The role of therapeutic leukapheresis in hyperleukocytotic AML.PLoS One. 2014 Apr 14;9(4).
• 12- Berber I, Kuku I, Erkurt MA, Kaya E, Gozukara Bag H, Nizam I et al. Leukapheresis in acute myeloid leukemia patients with hyperleukocytosis: A single center experience. Transfus Apher Sci. 2015 Oct;53(2):185-90.
• 13- Ressel A , Trümper L, Bäsecke J. Occlusion of the femoral arteries in de novo AML. Med Klin (Munich). 2007 May 15;102(5):388-92.