L-Asparginase Administration Reduces White Blood Cell Count and Prevents Tumor Lysis Syndrome in Children with Hyperleukocytic Acute Lymphoblastic Leukemia

被引:5
作者
Sondhi, Vishal [1 ]
Sharma, Aditi [1 ]
Taneja, Manish [1 ]
Arora, Brijesh [2 ]
Banavali, Sripad D. [2 ]
机构
[1] Armed Forces Med Coll, Dept Pediat, Pune 411040, Maharashtra, India
[2] Tata Mem Hosp, Dept Pediat Oncol, Bombay 400012, Maharashtra, India
关键词
Hyperleukocytosis; Hyperuricemia; Hyperkalemia; Hyperphosphatemia; Cytoreduction; MANAGEMENT; LEUKAPHERESIS; COMPLICATIONS; LEUKOSTASIS;
D O I
10.1159/000358115
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The management of hyperleukocytosis currently involves intensive supportive care for preventing tumor lysis syndrome (TLS)-associated metabolic abnormalities as well as cytoreduction procedures to reduce the white blood cell (WBC) count. These procedures are often equipment-intensive and may not be practised in developing countries with limited resources. Hence, it is not clear what would be the most effective strategy to manage hyperleukocytosis and prevent TLS. Procedure: All children <= 12 years, diagnosed with acute lymphoblastic leukemia (ALL) and hyperleukocytosis (WBC count > 100 x 10(9)/l) were administered L-asparginase (L-asp, 6,000 U/m(2), i.m.) along with standard supportive care consisting of hydration, oral allopurinol administration and alkalization. The complete blood counts and biochemical parameters were monitored for 72 h. After 48 h, if the WBC count was > 100 x 10(9)/l, a repeat dose of L-asp was administered. Results: Twenty-one children (9 boys and 12 girls) with hyperleukocytic ALL were treated with L-asp. The median age of the children was 5.3 years (range 2-11 years). The median initial WBC count was 249 x 10(9)/l (range 151-476 x 10(9)/l). Twenty children received only one dose of L-asp. The mean reduction in WBC count achieved by treatment was 15.7, 42.0, 61.0, 76.4, 85.5 and 90.8% at 12, 24, 36, 48, 60 and 72 h, respectively. None of the patients developed TLS. Conclusions: Chemical cytoreduction by administering L-asp is an effective means of managing hyperleukocytosis and preventing TLS. (C) 2014 S. Karger AG, Basel
引用
收藏
页码:6 / 9
页数:4
相关论文
共 10 条
[1]   Weekly polyethylene glycol conjugated L-asparaginase compared with biweekly dosing produces superior induction remission rates in childhood relapsed acute lymphoblastic leukemia: a pediatric oncology group study [J].
Abshire, TC ;
Pollock, BH ;
Billett, AL ;
Bradley, P ;
Buchanan, GR .
BLOOD, 2000, 96 (05) :1709-1715
[2]  
EGUIGUREN JM, 1992, BLOOD, V79, P871
[3]   Tumor Lysis Syndrome: A Systematic Review of Case Series and Case Reports [J].
Firwana, Belal M. ;
Hasan, Rim ;
Hasan, Nour ;
Alahdab, Fares ;
Alnahhas, Iyad ;
Hasan, Seba ;
Varon, Joseph .
POSTGRADUATE MEDICINE, 2012, 124 (02) :92-101
[4]   Hyperleukocytosis, leukostasis and leukapheresis: Practice management [J].
Ganzel, Chezi ;
Becker, Joanne ;
Mintz, Paul D. ;
Lazarus, Hillard M. ;
Rowe, Jacob M. .
BLOOD REVIEWS, 2012, 26 (03) :117-122
[5]   Leukapheresis and Exchange Transfusion in Children with Acute Leukemia and Hyperleukocytosis. A Single Center Experience [J].
Haase, R. ;
Merkel, N. ;
Diwan, O. ;
Eisner, K. ;
Kramm, C. M. .
KLINISCHE PADIATRIE, 2009, 221 (06) :374-378
[6]   Early complications in children with acute lymphoblastic leukemia presenting with hyperleukocytosis [J].
Lowe, EJ ;
Pui, CH ;
Hancock, ML ;
Geiger, TL ;
Khan, RB ;
Sandlund, JT .
PEDIATRIC BLOOD & CANCER, 2005, 45 (01) :10-15
[7]   Management of Hyperleukocytosis and Prevention of Tumor Lysis Syndrome with Low-Dose Prednisone Continuous Infusion in Children with Acute Lymphoblastic Leukemia [J].
Ozdemir, Mehmet Akif ;
Karakukcu, Musa ;
Patiroglu, Turkan ;
Torun, Yasemin Altuner ;
Kose, Mehmet .
ACTA HAEMATOLOGICA, 2009, 121 (01) :56-62
[8]   Leukocytoreduction for acute leukemia [J].
Porcu, P ;
Farag, S ;
Marcucci, G ;
Cataland, SR ;
Kennedy, MS ;
Bissell, M .
THERAPEUTIC APHERESIS, 2002, 6 (01) :15-23
[9]   Hyperleukocytic leukemias and leukostasis: A review of pathophysiology, clinical presentation and management [J].
Porcu, P ;
Cripe, LD ;
Ng, EW ;
Bhatia, S ;
Danielson, CM ;
Orazi, A ;
McCarthy, LJ .
LEUKEMIA & LYMPHOMA, 2000, 39 (1-2) :1-18
[10]   Glucocorticoid-induced apoptosis and glucocorticoid resistance: molecular mechanisms and clinical relevance [J].
Schmidt, S ;
Rainer, J ;
Ploner, C ;
Presul, E ;
Riml, S ;
Kofler, R .
CELL DEATH AND DIFFERENTIATION, 2004, 11 (Suppl 1) :S45-S55