Fadi G Haddad, Koji Sasaki, Jayastu Senapati, Lianchun Xiao, Grace Park, Tareq Abuasab, Sangeetha Venugopal, Daniel Rivera, Alexandre Bazinet, Rodrick Babakhanlou, Kunhwa Kim, Faustine Ong, Sai Desikan, Naveen Pemmaraju, Sanam Loghavi, Gautam Borthakur, Courtney DiNardo, Hussein A Abbas, Nicholas J Short, Naval Daver, Elias Jabbour, Guillermo Garcia-Manero, Farhad Ravandi, Hagop Kantarjian, Tapan Kadia
{"title":"Outcomes of Patients With Newly Diagnosed AML and Hyperleukocytosis.","authors":"Fadi G Haddad, Koji Sasaki, Jayastu Senapati, Lianchun Xiao, Grace Park, Tareq Abuasab, Sangeetha Venugopal, Daniel Rivera, Alexandre Bazinet, Rodrick Babakhanlou, Kunhwa Kim, Faustine Ong, Sai Desikan, Naveen Pemmaraju, Sanam Loghavi, Gautam Borthakur, Courtney DiNardo, Hussein A Abbas, Nicholas J Short, Naval Daver, Elias Jabbour, Guillermo Garcia-Manero, Farhad Ravandi, Hagop Kantarjian, Tapan Kadia","doi":"10.1200/OP.24.00027","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>AML presenting with hyperleukocytosis is associated with poor outcomes. We aim to understand the factors associated with early mortality and overall survival (OS) to help guide management and improve early mortality.</p><p><strong>Methods: </strong>We retrospectively reviewed data from 129 consecutive patients with newly diagnosed AML and a WBC count ≥100 × 10<sup>9</sup>/L between January 2010 and April 2020. Logistic regression models estimated odds ratios for 4-week mortality. Cox proportional hazard models estimated hazard ratios for OS.</p><p><strong>Results: </strong>The median age was 65 years (range, 23-86); the median WBC was 146 × 10<sup>9</sup>/L (range, 100-687). Seventy-five (58%) patients had clinical leukostasis (CL). <i>FLT3</i>, <i>NPM1</i>, and <i>RAS</i> pathway mutations were detected in 63%, 45%, and 27% of patients, respectively. Cytoreduction consisted of hydroxyurea in 124 (96%) patients, cytarabine in 69 (54%), and leukapheresis in 31 (24%). The cumulative 4-week and 8-week mortality rates were 9% and 13%, respectively, all in patients age 65 years and older. By multivariate analysis, older age, CL, and thrombocytopenia <40 × 10<sup>9</sup>/L were independently associated with a higher 4-week mortality rate. After a median follow-up of 49.4 months, the median OS was 14.3 months (95% CI, 7 to 21.6), with 4-year OS of 29%. Age 65 years and older, CL, tumor lysis syndrome, elevated LDH ≥2,000 U/L, elevated lactate ≥2.2 mmol/L, and poor-risk cytogenetics were independent factors associated with worse OS.</p><p><strong>Conclusion: </strong>Hyperleukocytosis is a life-threatening hematologic emergency. Early recognition and intervention including cytoreduction, blood product support, antibiotics, and renal replacement therapy may help mitigate the risk of morbidity and early mortality.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7000,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JCO oncology practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1200/OP.24.00027","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: AML presenting with hyperleukocytosis is associated with poor outcomes. We aim to understand the factors associated with early mortality and overall survival (OS) to help guide management and improve early mortality.
Methods: We retrospectively reviewed data from 129 consecutive patients with newly diagnosed AML and a WBC count ≥100 × 109/L between January 2010 and April 2020. Logistic regression models estimated odds ratios for 4-week mortality. Cox proportional hazard models estimated hazard ratios for OS.
Results: The median age was 65 years (range, 23-86); the median WBC was 146 × 109/L (range, 100-687). Seventy-five (58%) patients had clinical leukostasis (CL). FLT3, NPM1, and RAS pathway mutations were detected in 63%, 45%, and 27% of patients, respectively. Cytoreduction consisted of hydroxyurea in 124 (96%) patients, cytarabine in 69 (54%), and leukapheresis in 31 (24%). The cumulative 4-week and 8-week mortality rates were 9% and 13%, respectively, all in patients age 65 years and older. By multivariate analysis, older age, CL, and thrombocytopenia <40 × 109/L were independently associated with a higher 4-week mortality rate. After a median follow-up of 49.4 months, the median OS was 14.3 months (95% CI, 7 to 21.6), with 4-year OS of 29%. Age 65 years and older, CL, tumor lysis syndrome, elevated LDH ≥2,000 U/L, elevated lactate ≥2.2 mmol/L, and poor-risk cytogenetics were independent factors associated with worse OS.
Conclusion: Hyperleukocytosis is a life-threatening hematologic emergency. Early recognition and intervention including cytoreduction, blood product support, antibiotics, and renal replacement therapy may help mitigate the risk of morbidity and early mortality.