Initial respiratory status in hyperleukocytic acute myeloid leukemia: prognostic significance and effect of leukapheresis

This study investigated whether initial respiratory status in hyperleukocytic acute myeloid leukemia (AML), as defined by oxygen/ventilatory support, is (1) associated with early mortality and overall survival and (2) improved after leukapheresis. A retrospective chart review of 89 patients requiring leukapheresis was performed. White blood cell count (WBC) decreased from 153 (56-475)x10(9)/L to 60 (17-259)x10(9)/L after first leukapheresis (p<0.01). Initial respiratory status was room air (n=40), low (n=31) or high flow oxygen therapy (n=8) or mechanical ventilation (n=10). As compared to admission, respiratory status significantly deteriorated after both first and second leukapheresis (p<0.01) and was not different at day 5 for patients still alive (p=0.131). Both day 28 mortality and overall survival were significantly affected by initial respiratory status (p<0.01). Despite being effective in reducing WBC, leukapheresis did not improve respiratory status of hyperleukocytic AML patients, a factor strongly associated with survival.