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Annals of Oncology
acute complications pertaining to hyperleukocytosis in pediatric acute leukemia
patients prior to free availability of rasburicase, and without leucopheresis.
Method: Records of pediatric acute leukemia patients and “very high” leucocytosis
(VHL) (WBC > 100,000/mm 3 in AML and > 200,000/mm 3 in ALL) were analyzed.
None of these patients received rasburicase and /or leucopheresis. Patients were
managed with allopurinol and aggressive hydration. Data was analyzed for baseline
presentation, TLS and other complications pertaining to leucostasis.
Results: Out of 457 pediatric acute leukemia patients from Jun 2003-Dec 2009, there
were 45 (10%) patients with VHL. Median age was 10 years (SD-4.4; range 3-18) and
male: female ratio was 6.5:1. B-ALL, T-ALL and AML constituted 11 (24.4%), 16
(35.5%) and 18 (39.9%) patients respectively. Mean baseline WBC for ALL and AML
patients was 296,500/mm 3 (SD- 104,793; range 200,000-615,220) and 206,300/mm 3
(SD- 110,000; range 106,100-541,900) respectively. Laboratory TLS was seen in 17
(37.7%) patients [ 2 (4.4%) at baseline while 15 (33.3%) patients developed it after
chemotherapy initiation]. Clinical TLS was observed in 6 (13.3%) and renal
dysfunction in 7 (15.5%) patients; none required dialysis. CR was achieved in 32
(71.1%) pts and there were 3 (6.6%) deaths. No relation was seen between laboratory
TLS and baseline features or mortality. Thrombocytopenia below median (