Leukostasis followed by hemorrhage complicating the initiation of chemotherapy in patients with acute myeloid leukemia and hyperleukocytosis : A clinicopathologic report of four cases
✍ Scribed by Jens U. Würthner; Gabriele Köhler; Dirk Behringer; Albrecht Lindemann; Roland Mertelsmann; Michael Lübbert
- Publisher
- John Wiley and Sons
- Year
- 1999
- Tongue
- English
- Weight
- 504 KB
- Volume
- 85
- Category
- Article
- ISSN
- 0008-543X
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✦ Synopsis
Background:
Pulmonary and cerebral leukostasis, or parenchymal hemorrhage in these organs, are well-known early complications developing in patients with acute myeloid leukemia (aml), particularly when myelomonocytic features, hyperleukocytosis, and/or a coagulation disorder are initially present. commonly, these complications arise during increasing leukocyte counts (wbcs).
Methods:
The authors describe four patients with aml and hyperleukocytosis who developed leukostasis followed by parenchymal hemorrhage.
Results:
Bleeding in all patients occurred while their wbcs were decreasing following cytosine-arabinoside chemotherapy, and in the absence of disseminated intravascular coagulation or severe thrombocytopenia. radiologic and histopathologic findings underscoring possible mechanisms are presented in the article.
Conclusions:
Alterations of cell adhesion associated with chemotherapy-induced blast lysis or cellular differentiation are possible factors contributing to this particular sequence (cytosine arabinoside-based chemotherapy, leukostasis, and subsequent hemorrhage). prophylactic measures for managing this early complication of aml treatment include leukapheresis to reduce the wbc prior to the initiation of chemotherapy.