Acute Myeloid Leukemia (AML) - Leukapheresis

10/08/2003

Question: What is the efficacy of leukapheresis in acute myeloid leukemia?

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Unique Identifier:11699223

Authors: Giles FJ. Shen Y. Kantarjian HM. Korbling MJ. O'Brien S. Anderlini P. Donato M. Pierce S. Keating MJ. Freireich EJ. Estey E.

Institution: Departments of Leukemia, Biostatistics, and Blood and Marrow Transplantation, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 61, Houston, TX 77030, USA. fgiles@mdanderson.org

Title: Leukapheresis reduces early mortality in patients with acute myeloid leukemia with high white cell counts but does not improve long- term survival.

Source: Leukemia & Lymphoma. 42(1-2):67-73, 2001 Jun.

Abstract: PURPOSE: Current published data on therapeutic leukapheresis in hyperleucocytic AML does not define the impact on survival from this procedure. Between 1992 and 1999 we saw 146 patients with newly-diagnosed AML (APL excluded) and an initial WBC count > 50 x 10(9)/L of whom 71 underwent leukapheresis at the discretion of their treating doctors. We compared outcome (early mortality, CR, and overall survival) rates in the patients who were and were not pheresed. After accounting for covariates relevant to these outcomes, including age, performance status, and cytogenetics, there was evidence (p = .006) that pheresis reduced 2-week mortality rate and a suggestion (p = .06) that this resulted in a higher CR rate. However there was no evidence that pheresis lengthened longer-term or overall survival; if anything the suggestion was the converse (p = .06). These data may reflect the fact that the patients chosen to have pheresis were prognostically unfavorable as defined by variables that were not captured in our data set, since the alternative explanation i.e. that pheresis per se shortens overall survival seems less likely. Whether the above justifies the use of pheresis in the absence of evidence from a randomized trial is doubtful, but it seems likely that any long-term benefit to be derived from this procedure must await further advances in anti-leukemia therapy.

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Unique Identifier:9266944

Authors: Porcu P. Danielson CF. Orazi A. Heerema NA. Gabig TG. McCarthy LJ.

Institution: Department of Medicine, Indiana University Medical Center, Indianapolis 46202-5283, U.S.A.

Title: Therapeutic leukapheresis in hyperleucocytic leukaemias: lack of correlation between degree of cytoreduction and early mortality rate.

Source: British Journal of Haematology. 98(2):433-6, 1997 Aug.

Abstract: The clinical and laboratory data of 48 leukapheresis-treated patients with hyperleucocytic leukaemia (HL) was reviewed to assess the correlation between the degree of leucoreduction and early mortality. Leukapheresis resulted in > 50% leucoreductions and postapheresis WBC counts < 100 x 10(9)/l in most patients (64.5%). Patients presenting with neurological, respiratory or renal complications had higher early mortality rates than patients without such complications, despite similar initial WBC counts and comparable leucoreductions. Thus, in these patients, more efficient leucoreduction was not associated with improved early survival.