A Clinical Study On The Treatment Of Leukopheresis In Hyperleukocytic Acute Myeloid Leukemia

Objective：To compare the efficacy and toxicity between leukopheresis regimen andhydroxyurea regimen in Hyperleukocytic Acute Myeloid Leukemia（HL-AML） byretrospective analysis.Methods：52cases with HL-AML（non M3） which were diagnosed primary anduntreated between June2006and October2011were collected from our hospital.Thediagnostic criteria was based on internal diagnostic criteria,and they were treated withleukopheresis regimen and hydroxyurea regimen.Blood cell analysis,serumelectrolytes (potassium,phosphorus,calcium),uric acid, renal and liver function,bloodcoagulation,bone marrow aspiration and imaging were chosen as evaluationindexes.We analyzed measurement data with t text or rank sum test,count data withχ~2text,repeated measurement date with ANOVA of repeated measurementdesign,calculated overall survival(OS) and disease free survival(DFS) withKaplan-Meier and Log-rank text, P＜0.05has statistic significance.Results：1. Curative effect of lowering haemocyte count:Both the decrease ofleukocytic count and platelet count in leukopheresis regimen and hydroxyurearegimen weren’t distinctly diffrent after therapy(P＜0.05).The reduction ofhaematoglobin in leukopheresis regimen was （9.32±13.39） g/L,which was（8.81±10.70）g/L in hydroxyurea regimen. The statistics analysis showed P=0.039（P＜0.05）,which meaned the reduction of haematoglobin in leukopheresis regimenwas larger than in hydroxyurea regimen.The average time needed to lower haemocytecount in leukopheresis regimen was (1.76±0.83)d,which was （5.22±1.58）d in hydroxyurea regimen. The statistics analysis showed P=0.000（P＜0.05）,whichmeaned the average time to lower haemocyte count in leukopheresis regimen wasshorter than in hydroxyurea regimen.2. Evaluation indexes: The incidence of visceral hemorrhage in leukopheresisregimen was4.2%,which was25.9%in hydroxyurea regimen. The statistics analysisshowed P=0.033（P＜0.05）,which meaned the leukopheresis regimen is better thanthe hydroxyurea regimen in decreasing the incidence of visceral hemorrhage.Theincidence of TLS in leukopheresis regimen was0,which was14.8%in hydroxyurearegimen. The statistics analysis showed P=0.045（P＜0.05），which meaned theleukopheresis regimen had lower incidence of TLS than the hydroxyurea regimen.There were’t significant diffrences（P＞0.05）between leukopheresis regimen andhydroxyurea regimen in the incidence of ARDS and DIC.The ED rate inleukopheresis regimen was4%,which was14.8%in hydroxyurea regimen. Thestatistics analysis showed P=0.029（P＜0.05）,which meaned the ED rate inleukopheresis regimen was lower than that in hydroxyurea regimen. Aftercombination chemotherapy, the leukopheresis regimen had a complete remission rateof60.9%,while the hydroxyurea regimen was30.0%. The statistics analysis showedP=0.043（P＜0.05）， which meaned the leukopheresis regimen was better inimproving CR rate than the hydroxyurea regimen.The average time to achieve CR inleukopheresis regimen was (44.21±13.67)d,which was (62.17±23.83)d in hydroxyurearegimen. The statistics analysis showed P=0.045（P＜0.05）,which meaned theleukopheresis regimen significantly shortened the time needed to achieve CRcompared with the hydroxyurea regimen.3.Other Evaluation indexes: The two groups were’t significant diffrent in theimprovement rates of stasis symptom of CNS and fever（P＞0.05）.The volume ofspleen decreased by (2.89±0.78)cm in leukopheresis regimen,which was(2.31±0.48)cm in hydroxyurea regimen. The statistics analysis showed P=0.043（P＜0.05）， which meaned the leukopheresis regimen was better in improvingsplenomegaly and reducing tumor burden than the hydroxyurea regimen. Theimprovement rate of dysfunction of blood coagulation in leukopheresis regimen was 100%,which was25%in hydroxyurea regimen. The statistics analysis showedP=0.047（P＜0.05）,which meaned patients with dysfunction of blood coagulationcould benefit more with leukopheresis regimen than hydroxyurea regimen.4.Side effects:The main side effects in leukopheresis regimen were hypocalcemiaand venous puncture site hematoma,which were gastrointestinal symptoms and rash inhydroxyurea regimen.The side effects in both groups were low-grade and all thepatients recovered quickly after supportive treatment.Both were safty, welltolerated,and didn’t influence the treatment.5.Follow-up：The mean OS in leukopheresis regimen was21.74months,whichwas15.97months in hydroxyurea regimen, The statistics analysis showed P=0.253（P＞0.05）.The mean PFS in leukopheresis regimen was21.23months,which was16.6months in hydroxyurea regimen, The statistics analysis showed P=0.517（P＞0.05）.There were not statistically significant differences in the estimated mean OS and PFSbetween the two groups.Conclusion：1.Leukopheresis regimen has notably more advantages in rapidlyreducing leukocytic count on the HL-AML patients than hydroxyurea regimen.Andthe side effedts is low-grade and well tolerated.Therefor, it should be considered asthe preferred regiment.2.Leukopheresis regimen is effective to improve the stasis symptom caused byleucocytosis and to decrease tumor burden.It significantly reduces the incidence ofcomplications and early mortality in order to allow to receive subsequent standardchemotherapy.3.For a large number of leukocytic is removed by leukopheresisregimen,chemotherapy is allowed to give full performent and the CR rate issignificantly improved.What’s more,the time to CR is shortened,the same as the timeof hospitalization.