High dose cyclophosphamide for cytoreduction in patients with acute myeloid leukemia with hyperleukocytosis or leukostasis.
Jennifer ZhaoJan Philipp BewersdorfSara JaszczurAndrew KowalskiSarah PerreaultMolly SchifferSteven GoreNikolai PodoltsevThomas PrebetRory Michael ShallisAmer M ZeidanPublished in: Leukemia & lymphoma (2020)
Hyperleukocytosis may lead to multiple medical emergencies. Hydroxyurea, intensive chemotherapy, and leukapheresis are used for cytoreduction. However, there is little data regarding the best approach. Here, we report on the efficacy and safety of high dose cyclophosphamide (HDCy; 60 mg/kg). 27 patients with acute myeloid leukemia or blast phase chronic myeloid leukemia who presented with white blood cell count (WBC) of ≥50x109/L or symptoms of leukostasis were treated with HDCy. Primary endpoint was early mortality (death within seven days of admission). Median WBC was 107 × 109/L at time of HDCy; 74% had leukostasis symptoms at presentation. Eight (29.6%) patients died within seven days of admission. Sustained WBC reduction was achieved in 18/24 (75%) evaluable patients with median nadir of 0.25 × 109/L. Adverse effects attributed to HDCy included tumor lysis syndrome (n = 7; 25.9%), disseminated intravascular coagulopathy (n = 5; 18.5%), and hemorrhagic cystitis (n = 1; 3.7%). HDCy was effective for cytoreduction and adverse effects were acceptable.
Keyphrases
- high dose
- acute myeloid leukemia
- low dose
- stem cell transplantation
- chronic myeloid leukemia
- end stage renal disease
- emergency department
- newly diagnosed
- ejection fraction
- chronic kidney disease
- allogeneic hematopoietic stem cell transplantation
- healthcare
- case report
- single cell
- peritoneal dialysis
- coronary artery
- stem cells
- prognostic factors
- cardiovascular disease
- cardiovascular events
- risk factors
- mesenchymal stem cells
- machine learning
- patient reported outcomes
- bone marrow
- big data
- artificial intelligence
- coronary artery disease
- acute lymphoblastic leukemia