Bowel, lung, and retinal ischemia: Rare manifestations of leukostasis syndrome in a man with chronic lymphocytic leukemia—A case report and review of the literature

Leukapheresis is a resource-intensive and high-risk treatment with unclear benefits when used for leukostasis syndrome in hematologic malignancies. In this case report and literature review we discuss the pathophysiology of leukostasis syndrome associated with chronic lymphocytic leukemia (CLL) and the rapidly evolving paradigm of CLL treatment through the lens of a 51-year-old man who was diagnosed with CLL. He presented with clinical manifestations of leukostasis syndrome with an absolute lymphocyte count of 522.6×109/L. We identified 15 additional cases of CLL-associated leukostasis syndrome in our literature review. Pulmonary and neurologic manifestations of leukostasis were most common. In combination with pharmacologic cytoreduction, leukapheresis was used successfully in most cases with few reports of complications. In the context of greater adoption of first line therapies for CLL that are known to induce transient leukocytosis, we explore leukapheresis as an adjunctive therapy that can rapidly reduce the lymphocyte count and in select instances possibly mitigate the effects of Bruton's tyrosine kinase inhibitor-induced hyperleukocytosis.