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Hyperleucocytosis in paediatric acute myeloid leukaemia: the challenge of white blood cell counts above 200 x 109/l. The NOPHO experience 1984-2014
Oslo Univ Hosp, Div Paediat & Adolescent Med, Mailbox 4950 Nydalen, N-0424 Oslo, Norway..
Oslo Univ Hosp, Div Paediat & Adolescent Med, Mailbox 4950 Nydalen, N-0424 Oslo, Norway..
Umea Univ Hosp, Dept Med Biosci, Genet, Umea, Sweden..
Queen Mary Hosp, Dept Paediat & Adolescent Med, Hong Kong, Hong Kong, Peoples R China.;HKPHOSG, Hong Kong, Hong Kong, Peoples R China..
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2017 (English)In: British Journal of Haematology, ISSN 0007-1048, E-ISSN 1365-2141, Vol. 178, no 3, 448-456 p.Article in journal (Refereed) Published
Abstract [en]

Hyperleucocytosis in paediatric acute myeloid leukaemia (AML) is associated with increased morbidity and mortality. We studied hyperleucocytosis in 890 patients with AML aged 0-18 years registered in the Nordic Society of Paediatric Haematology and Oncology (NOPHO) registry, with special focus on very high white blood cell counts (WBC > 200 x 10/l). Eighty-six patients (10%) had WBC 100-199 x 109/l and 57 (6%) had WBC >= 200 x 109/l. Patients with WBC >= 200 x 109/l had a high frequency of t(9;11) and a paucity of trisomy 8. Due to the high frequency of deaths within the first 2 weeks (30% vs. 1% for all others), overall survival in this group was inferior to patients with WBC <200 x 109/l (39% vs. 61%). Main cause of early death was intracranial haemorrhage and leucostasis. Twenty-six per cent of these patients never started antileukaemic protocol therapy. Leukapheresis or exchange transfusion was used in 24% of patients with hyperleucocytosis without impact on survival. Patients with hyperleucocytosis surviving the first week had identical survival as patients with lower WBC. We conclude that death within the first days after diagnosis is the major challenge in patients with high WBC and advocate rapid initiation of intensive chemotherapy.

Place, publisher, year, edition, pages
2017. Vol. 178, no 3, 448-456 p.
Keyword [en]
hyperleucocytosis, acute myeloid leukaemia, children, early death, leukapheresis
National Category
Hematology
Identifiers
URN: urn:nbn:se:uu:diva-332922DOI: 10.1111/bjh.14692ISI: 000406058400013PubMedID: 28542715OAI: oai:DiVA.org:uu-332922DiVA: diva2:1157817
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2017-11-16Bibliographically approved

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Palle, Josefine

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