HİPERLÖKOSİTOZ 

Tanım: Hiperlökositoz konvansiyonel olarak dolaşımdaki lökositlerin veya lösemik blast hücrelerinin sayısının >100×109/L olması şeklinde tanımlanmaktadır. Lökosit yüksekliği ile ilişkili lökostaz komplikasyonları; infeksiyon, tromboembolizm veya altta yatan bir etiyoloji olmaksızın dolaĢımda lösemik myeloid veya lenfoid blast hücrelerinin aşırı yüküne bağlı direkt organ ya da doku fonksiyon bozukluğu olarak nitelendirilebilir. 

Gerekçe: Lökostaza neden olan lökositlerin ve blastların dolaşımdan uzaklaştırılması amacı ile yapılır. 

İşlem: Lökositaferezi 

İşlenen Volüm: 1.5-2TKH 

Sıklığı: Günlük, yaşamı tehdit eden durumda günde iki kez 

Replasman Sıvısı: Kristaloid (SF), albumin, plazma 

Uygulama sayı ve/veya süresi: Asemptomatik AML hastalarının profilaksisinde, blastik hücre sayısı <100×109/L (monositik alt tip bulunan hastalar yakın takip edilmelidir) olunca tedavi sonlandırılır. Lökostaz komplikasyonları olan AML hastalarında, blastik hücre sayısı <50-100×109/L olunca ve klinik bulgular düzelince tedavi sonlandırılır. Asemptomatik ALL hastalarının profilaksisinde, blastik hücre sayısı <150×109/L olunca tedavi sonlandırılır. Lökostaz komplikasyonları olan ALL hastalarında, blast sayısı <100×109/L olunca ve klinik bulgular düzelince tedavi sonlandırılır. 

YARARLANILAN LİTERATÜRLER

*Abla O, Khanani MF, Hitzler JK, Sung L, Geary D, Abdelhaleem M, Weitzman S, Naqvi A. Complications of hyperleukocytosis and leukapheresis in pediatric acute leukemia. Blood 2004;104:(abstract) 1963. 

*Giles FJ, Shen Y, Kantarjian HM, Korbling MJ, O‘Brien S, Anderlini P, Donato M, Pierce S, Keating MJ, Freireich EJ, Estey E. Leukapheresis reduces early mortality in patients with acute myeloid leukemia with high white cell counts but does not improve long- term survival. Leuk Lymphoma 2001;42:67–73. 

*Kuruvilla JG, Greenwood MD, Hogge DE, Nantel SH, Lavoie JC, Toze CL, Shepherd JD, Sutherland HJ, Benny WB, Petraszko TR, Sreenivasan GM, Nevill TJ. Outcome for patients with acute myelogenous leukemia and hyperleukocytosis requiring urgent leukapheresis at diagnosis. Blood 2002;100:(abstract) 4598. 

*Lowe EJ, Pui CH, Hancock ML, Geiger TL, Khan RB, Sandlund JT. Early complications in children with acute lymphoblastic leukemia presenting with hyperleukocytosis. Pediatric Blood Cancer 2005;45:10–15.

*Porcu P, Farag S, Marcucci G, Cataland SR, Kennedy MS, Bissell M. Leukocytoreduction for acute leukemia. Ther Apher 2002;6:15–23. 

*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. 

*Novotny JR, Muller-Beissenhirtz H, Herget-Rosenthal S, Kribben A, Duhrsen U. Grading of symptoms in hyperleukocytic leukaemia: a clinical model for the role of different blast types and promyelocytes in the development of leukostasis syndrome. Eur J Haematol 2005;74:501–510. 

*Piccirillo N, Laurenti L, Chiusolo P, Sora F, Bianchi M, De Matteis S, Pagano L, Zini G, D‘Onofrio G, Leone G, Sica S. Reliability of leukostasis grading score to identify patients with high-risk hyperleukocytosis. Am J Hematol 2009;84:381–382. 

*Marbello L, Ricci F, Nosari AM, Turrini M, Nador G, Nichelatti M, Tedeschi A, Vismara E, Morra E. Outcome of hyperleukocytic adult acute myeloid leukaemia: a single-center retrospective study and review of literature. Leuk Res 2008;32:1221–1227. 

*Inaba H, Fan Y, Pounds S, Geiger TL, Rubnitz JE, Ribeiro RC, Pui CH, Razzouk BI. Clinical and biologic features and treatment outcome of children with newly diagnosed acute myeloid leukemia and hyperleukocytosis. Cancer 2008;113:522– 529. 

*Chang MC, Chen TY, Tang JL, Lan YJ, Chao TY, Chiu CF, Ho HT. Leukapheresis and cranial irradiation in patients with hyperleukocytic acute myeloid leukemia: no impact on early mortality and intracranial hemorrhage. Am J Hematol 2007;82:976–980. 

*Bug G, Anargyrou K, Tonn T, Bialleck H, Seifried E, Hoelzer D, Ottmann OG. Impact of leukapheresis on early death rate in adult acute myeloid leukemia presenting with hyperleukocytosis. Transfusion 2007;47:1843–1850. 

*Balint B, Ostojic G, Pavlovic M, Hrvacevic R, Tukic L, Radovic M. Cytapheresis in the treatment of cell-affected blood disorders and abnormalities. Transfus Apher Sci 2006; 35:25–31. 

*Tan D, Hwang W, Goh YT. Therapeutic leukapheresis in hyperleukocytic leukaemias—the experience of a tertiary institution in Singapore. Ann Acad Med Singapore 2005;34:229–234. 

*Thiebaut A, Thomas X, Belhabri A, Anglaret B, Archimbaud E. Impact of pre-induction therapy leukapheresis on treatment outcome in adult acute myelogenous leukemia presenting with hyperleukocytosis. Ann Hematol 2000;79:501–506. 

*Eguiguren JM, Schell MJ, Crist WM, Kunkel K, Rivera GK. Complications and outcome in childhood acute lymphoblastic leukemia with hyperleukocytosis. Blood 1992;79:871–875. 

*Maurer HS, Steinherz PG, Gaynon PS, Finklestein JZ, Sather HN, Reaman GH, Bleyer WA, Hammond GD. The effect of initial management of hyperleukocytosis on early complications and outcome of children with acute lymphoblastic leukemia. 

J Clin Oncol 1988;6:1425–1432. 

*Ventura GJ, Hester JP, Smith TL, Keating MJ. Acute myeloblastic leukemia with hyperleukocytosis: risk factors for early mortality in induction. Am J Hematol 1988;27:34–37.