Leukapheresis versus no leukapheresis for hyperleukocytosis in acute myeloid leukemia: an updated systematic review and meta-analysis of early mortality.

IF 2.8 4区医学 Q2 HEMATOLOGY

Expert Review of Hematology Pub Date : 2026-08-01 Epub Date: 2026-05-27 DOI:10.1080/17474086.2026.2680138

Jamiel Reyes, Alexander Reyes

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引用次数: 0

Abstract

Introduction: Leukapheresis is used for rapid cytoreduction in adults with acute myeloid leukemia (AML) and hyperleukocytosis, but its effect on early mortality remains uncertain. We performed an updated systematic review and meta-analysis of comparative studies.

Methods: MEDLINE, CENTRAL, ClinicalTrials.gov, Google Scholar, and citation searching were searched from inception to March 2026. Comparative studies of leukapheresis versus no leukapheresis in adults with AML and hyperleukocytosis were included. Risk of bias was assessed using ROBINS-I, and certainty of evidence was assessed using GRADE. Random-effects meta-analysis of crude 2 × 2 data was performed using odds ratios (ORs).

Results: Thirteen retrospective comparative studies were included; 10 studies comprising 1,406 patients contributed to the primary 30-day mortality analysis. Leukapheresis was not clearly associated with lower 30-day mortality compared with no leukapheresis (OR 0.94, 95% CI 0.65-1.34; I² = 0.0%). Only one study reported an adjusted estimate. Most studies were at serious risk of bias, and certainty of evidence was very low.

Conclusions: Current non-randomized evidence does not establish a reliable early-mortality benefit of leukapheresis. Confounding 3by indication remains a major limitation.

Registration: This study was prospectively registered on PROSPERO (identifier: CRD420261351743).

查看原文本刊更多论文

急性髓性白血病中白细胞增多症的白细胞分离与无白细胞分离：早期死亡率的最新系统评价和荟萃分析。

白细胞分离术用于急性髓性白血病（AML）和白细胞增多症的成人患者的快速细胞减少，但其对早期死亡率的影响仍不确定。我们对比较研究进行了更新的系统回顾和荟萃分析。方法：检索自成立至2026年3月的MEDLINE、CENTRAL、ClinicalTrials.gov、谷歌Scholar和引文检索。包括白血病和高白细胞增多症的成人白血病患者的白细胞分离与无白细胞分离的比较研究。使用ROBINS-I评估偏倚风险，使用GRADE评估证据的确定性。采用优势比（ORs）对粗2 × 2数据进行随机效应荟萃分析。结果：纳入13项回顾性比较研究；包括1,406例患者的10项研究对初级30天死亡率进行了分析。与无白细胞分离相比，白细胞分离与较低的30天死亡率没有明显相关性（OR 0.94, 95% CI 0.65-1.34; I2 = 0.0%）。只有一项研究报告了调整后的估计。大多数研究存在严重的偏倚风险，证据的确定性非常低。结论：目前的非随机证据并不能确定白细胞摘除术对早期死亡率有可靠的益处。适应症的混淆仍然是主要的限制。注册：本研究在PROSPERO（识别码：CRD420261351743）进行前瞻性注册。

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来源期刊

Expert Review of Hematology HEMATOLOGY-

CiteScore

4.70

自引率

3.60%

发文量

审稿时长

6-12 weeks

期刊介绍： Advanced molecular research techniques have transformed hematology in recent years. With improved understanding of hematologic diseases, we now have the opportunity to research and evaluate new biological therapies, new drugs and drug combinations, new treatment schedules and novel approaches including stem cell transplantation. We can also expect proteomics, molecular genetics and biomarker research to facilitate new diagnostic approaches and the identification of appropriate therapies. Further advances in our knowledge regarding the formation and function of blood cells and blood-forming tissues should ensue, and it will be a major challenge for hematologists to adopt these new paradigms and develop integrated strategies to define the best possible patient care. Expert Review of Hematology (1747-4086) puts these advances in context and explores how they will translate directly into clinical practice.