Leukapheresis for the management of hyperleukocytosis in acute myeloid leukemia—A systematic review and meta‐analysis

Background Up to 20% of patients with acute myeloid leukemia (AML) present with hyperleukocytosis, usually defined as a white blood cell (WBC) count greater than 100 × 109/L. Given the high early mortality rate, emergent cytoreduction with either leukapheresis, hydroxyurea, or chemotherapy is indica...

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Published inTransfusion (Philadelphia, Pa.) Vol. 60; no. 10; pp. 2360 - 2369
Main Authors Bewersdorf, Jan P., Giri, Smith, Tallman, Martin S., Zeidan, Amer M., Stahl, Maximilian
Format Journal Article
LanguageEnglish
Published Hoboken, USA John Wiley & Sons, Inc 01.10.2020
Wiley Subscription Services, Inc
Subjects
Acute myeloid leukemia
Chemotherapy
Clinical trials
Complications
Confidence intervals
Heterogeneity
Hydroxyurea
Leukapheresis
Leukemia
Leukocytes
Meta-analysis
Mortality
Myeloid leukemia
Patients
Statistical analysis
Systematic review
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Summary:Background Up to 20% of patients with acute myeloid leukemia (AML) present with hyperleukocytosis, usually defined as a white blood cell (WBC) count greater than 100 × 109/L. Given the high early mortality rate, emergent cytoreduction with either leukapheresis, hydroxyurea, or chemotherapy is indicated, but the optimal strategy is unknown. Study Design and Methods For this systematic review and meta‐analysis we searched MEDLINE and EMBASE via Ovid, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from inception through March 2020 for multiarm studies comparing early mortality rates of patients with AML treated with leukapheresis and those who were not. The risk ratio (RR) of early death for patients who received leukapheresis vs patients who did not was estimated using a sum of the log‐ratio of individual study estimates weighted by sample size. Results Among 13 two‐arm, retrospective studies with 1743 patients (486 leukapheresis and 1257 nonleukapheresis patients), leukapheresis did not improve the primary outcome of early mortality compared to treatment strategies in which leukapheresis was not used (RR, 0.88; 95% confidence interval [CI], 0.69‐1.13; P = .321) without statistically significant heterogeneity between studies (Cochranʼs Q, 18; P = .115; I2, 33.4%). Patients presenting with clinical leukostasis tended to be more likely to undergo leukapheresis (odds ratio, 2.01; 95% CI, 0.99‐4.08; P = .052). Conclusion As we did not find evidence of a short‐term mortality benefit and considering the associated complications and logistic burden, our results argue against the routine use of leukapheresis for hyperleukocytosis among patients with AML. See editorial on page 2161–2163, in this issue
Bibliography:Funding information
National Institutes of Health, Grant/Award Numbers: P30 CA008748, P30 CA016359
Amer Zeidan is a Leukemia and Lymphoma Society Scholar in Clinical Research and is also supported by a National Cancer Institute (NCI) Cancer Clinical Investigator Team Leadership Award. Maximilian Stahl received funding from the Memorial Sloan Kettering Cancer Center Clinical Scholars T32 Program under award number 2T32 CA009512‐31. Research reported in this publication was supported by the NCI of the National Institutes of Health under Award Number P30 CA016359 to Yale Comprehensive Cancer Center and Cancer Center Support Grant/Core Grant to Memorial Sloan Kettering Cancer Center (P30 CA008748). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
A.M. Z. and M.S. contributed equally to this study.
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ISSN:0041-1132
1537-2995
DOI:10.1111/trf.15994