| Acute promyelocytic leukemia (APL) is a specific subtype of acute myelocytic leukemia (AML) which accounts for 10-15% of adult AML.With the widespread application of induction and differentiation therapy which is initiated by Chinese, 90% of APL patients could accept complete remission and 70-80% gain disease free survival in five years even longer. So at present APL is considered to be one kind of malignant diseases of hematologic system with high recovery rate. However, hyperleukocytosis (WBC>10×109/L), whicn often occurs during the process of induction and differentiation therapy with incidence of 30-80%, can lead to hyperleukocytosis syndrome that involves brain,lung,heart and other important organs and severe disseminated intravascular coagulation which treaten to life. Fever, dyspnea, swelling of the tissue, coma, cardiac failure, renal failure may occur and the patients may be in high risk of death with early mortality of 10%. Therefore, it is considerable to treat hyperleukocytosis as early as possible.We analyse 67 patients who were newly diagnosed as APL from January 2003 to January 2007 and treated with ATRA and ATO retrospectively in order to approach the best dosage and opportunity of hydroxyurea on hyperleukocytosis. We also compare hydroxyurea with leukapheresis as the role in treating hyperleukocytosis.Methods: Standard dosage group (Hu<3g/L),median dosage group (3≤Hu<6.0g/d) and high dosage group (Hu≥6.0g/d, with maximum 9.0g/d) aredivided based on the maximum dosage of hydroxyurea every day. Less than 20,000 group,20,000 to 40,000 group and more than 40,000 group are divided according to the WBC count when hydroxyurea is added. Leukopheresis group (10 patients with median WBC 39.7×109/L when hospitalized) and hydroxyurea group (12 patients with median WBC 37.57×109/L when hospitalized) are compared. 31 patient who came to hospital regularly, of whom 7 patients with peripheral WBC less than normal and 24 patients with normal peripheral WBC when they arrived at hospital the second time,are classified as WBC less than normal group and normal WBC group. Analyses were performed on the SAS 8.2 (SAS, Inc, Cary, NC).Results: (1) 55 patients (55/57) accepts complete remission, 2 patients (2/57) died at the early time.The wbc peak count between three group has no difference statistically; Time to maximum count and normal after hydroxyurea usage shows no difference; transfused platelet,transfused red blood cell and transfused plasma shows no difference; The incidence rate of complication of hemorrhage also shows no difference between the different dosage group. (2) There is statistical difference of wbc peak count between three various application opportunity group. the later we use hydroxyurea, the higher wbc count. Other indexs such as time to maximum count,lasting time of hyperleukocytosis,transfused red blood cell count,transfused plsma count and complication of hemorrhage show no difference. (3) The wbc peak count,lasting time of hyperleukocytosis,the maximum wbc multiple,transfused platelet,transfused red blood cell count show difference statistically. But complication of hemorrhage shows no difference. (4)There is no statistical difference between WBC less than normal group and normal WBC group in the index of onset wbc,accumulative hydroxyurea dosage and time. (5) Based on the above results,we discuss the case in details in the article to make sure the direction of Hu further.Conclusion: (1) Various dosage hydroxyurea could control hyperleukocytosis effectively,shorten the lasting time of hyperleukocytosis,reduce the risk,of which early application (WBC<20×10~9/L) and high dosage (≥6g/d, maximum9g) retain dominance. We suggested using hydroxyurea even white blood cell count is normal. (2) It is cheap and safe to use hydroxyurea of early and high dosage. (3) Comparing leukapheresis, it is economic and effective to use hydroxyurea if a patient shares high level WBC count (WBC≥40×10~9/L).
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