Hyperleukocytosis in Childhood Acute Leukemia: Early Complications and Survival Outcomes
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
3.1. Study Population
3.2. Hyperleukocytosis in Acute Lymphoblastic Leukemia
3.3. Hyperleukocytosis in Acute Myeloid Leukemia
3.4. Survival Outcomes in Acute Lymphoblastic Leukemia
3.5. Survival Outcomes in Acute Myeloid Leukemia
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Total (N = 483) | Hyperleukocytosis (N = 80) | No Hyperleukocytosis (N = 403) | p Value |
---|---|---|---|---|
Demographic and clinical characteristics, n (%) | ||||
Age (months), median (IQR) | 54.0 (36.0–97.0) | 91.0 (34.0–137.0) | 52.0 (36.0–86.0) | 0.013 |
Sex | 0.171 | |||
Male | 272 (56.3) | 39 (48.8) | 233 (57.8) | |
Female | 211 (43.7) | 41 (51.2) | 170 (42.2) | |
Immunophenotype | <0.001 | |||
T-cell | 63 (13.0) | 25 (31.2) | 38 (9.4) | |
B-cell | 376 (77.9) | 51 (63.8) | 325 (80.7) | |
FAB classification | 44 (9.1) | 4 (5.0) | 40 (9.9) | |
Fever | 360 (74.5) | 62 (77.5) | 298 (73.9) | 0.599 |
Mediastinal mass | 23 (4.8) | 8 (10.0) | 15 (3.7) | 0.037 |
Hepatomegaly | 448 (92.8) | 80 (100.0) | 368 (91.3) | 0.012 |
Splenomegaly | 332 (68.7) | 72 (90.0) | 260 (64.5) | <0.001 |
Laboratory parameters, mean (SD) | ||||
Hemoglobin (g/dL) | 7.5 (3.5) | 7.0 (2.7) | 7.6 (3.7) | 0.223 |
Platelet count (×109/L) | 75.5 (92.3) | 38.0 (29.9) | 82.9 (98.5) | <0.001 |
Blast cells (%) | 50.2 (34.8) | 90.4 (11.5) | 42.2 (32.2) | <0.001 |
Calcium (mmol/L) | 9.6 (1.1) | 9.3 (0.9) | 9.6 (1.1) | 0.018 |
Phosphorus (mmol/L) | 4.8 (1.3) | 4.1 (1.5) | 5 (1.3) | <0.001 |
Uric acid (mmol/L) | 6.1 (3.5) | 7.5 (4.1) | 5.9 (3.3) | <0.001 |
Lactate dehydrogenase (U/L) | 2776.3 (5339.4) | 4971.5 (7105.8) | 2350.3 (4820.7) | <0.001 |
Treatment-related complications, n (%) | ||||
Tumor lysis syndrome | 67 (13.9) | 24 (30.0) | 43 (10.7) | <0.001 |
Seizure | 21 (4.3) | 9 (11.3) | 12 (3.0) | 0.003 |
Intracranial hemorrhage | 6 (1.2) | 3 (3.8) | 3 (0.7) | 0.056 |
Acute kidney injury | 27 (5.6) | 9 (11.3) | 18 (4.5) | 0.025 |
Septic shock | 106 (21.9) | 26 (32.5) | 80 (19.9) | 0.009 |
DIC | 65 (13.5) | 21 (26.3) | 44 (10.9) | <0.001 |
ETT intubation | 38 (7.9) | 14 (17.5) | 24 (6.0) | <0.001 |
ICU admission | 50 (10.4) | 22 (27.5) | 28 (6.9) | <0.001 |
Treatment outcomes, n (%) | ||||
Induction of remission | 428 (96.8) | 63 (91.3) | 365 (97.9) | 0.011 |
Relapse | 162 (33.5) | 31 (38.8) | 131 (32.5) | 0.342 |
Mortality | 207 (42.9) | 53 (66.3) | 154 (38.2) | <0.001 |
Variables | Total (N = 207) | Hyperleukocytosis (N = 42) | No Hyperleukocytosis (N = 165) | p Value |
---|---|---|---|---|
Demographic and clinical characteristics, n (%) | ||||
Age (months), median (IQR) | 65.0 (25.5–133.5) | 137.0 (34.0–150.5) | 58.0 (25.0–116.0) | 0.021 |
Sex | 0.268 | |||
Male | 125 (60.4) | 29 (69.0) | 96 (58.2) | |
Female | 82 (39.6) | 13 (31.0) | 69 (41.8) | |
Fever | 157 (75.8) | 39 (92.9) | 118 (71.5) | 0.007 |
Hepatomegaly | 165 (79.7) | 37 (88.1) | 128 (77.6) | 0.194 |
Splenomegaly | 119 (57.5) | 31 (73.8) | 88 (53.3) | 0.026 |
Lymphadenopathy | 142 (68.6) | 35 (83.3) | 107 (64.8) | 0.034 |
Laboratory parameters, mean (SD) | ||||
Hemoglobin (g/dL) | 7.3 (2.2) | 7.1 (1.6) | 7.3 (2.3) | 0.585 |
Platelet count (×109/L) | 64.1 (93.1) | 50.0 (35.3) | 67.7 (102.5) | 0.272 |
Blast cells (%) | 43.4 (34.7) | 80.5 (24.7) | 33.9 (30.3) | <0.001 |
Calcium (mmol/L) | 9.3 (0.7) | 9.0 (0.9) | 9.3 (0.7) | 0.021 |
Phosphorus (mmol/L) | 4.6 (1.2) | 4.1 (1.4) | 4.8 (1.0) | <0.001 |
Uric acid (mmol/L) | 5.0 (2.1) | 6.0 (2.6) | 4.8 (1.9) | <0.001 |
Lactate dehydrogenase (U/L) | 2035.6 (2210.0) | 2619.7 (2425.5) | 1888.6 (2135.3) | 0.058 |
Treatment-related complications, n (%) | ||||
Tumor lysis syndrome | 11 (5.3) | 4 (9.5) | 7 (4.2) | 0.276 |
Seizure | 8 (3.9) | 1 (2.4) | 7 (4.2) | 1 |
Intracranial hemorrhage | 2 (1.0) | 2 (4.8) | 0 (0) | 0.037 |
Acute kidney injury | 14 (6.8) | 2 (4.8) | 12 (7.3) | 1 |
Septic shock | 59 (28.5) | 11 (26.2) | 48 (29.1) | 1 |
DIC | 49 (23.7) | 13 (31.0) | 36 (21.8) | 0.219 |
ETT intubation | 41 (19.8) | 8 (19.0) | 33 (20.0) | 1 |
ICU admission | 46 (22.2) | 11 (26.2) | 35 (21.2) | 0.504 |
Treatment outcomes, n (%) | ||||
Induction of remission | 109 (67.3) | 19 (59.3) | 90 (69.2) | 0.289 |
Relapse | 63 (30.4) | 12 (28.6) | 51 (30.9) | 0.915 |
Mortality | 160 (77.3) | 34 (81.0) | 126 (76.4) | 0.669 |
Risk Factor | Crude HR (95% CI) | Adjusted HR (95% CI) | p Value |
---|---|---|---|
Age (years) | |||
1–9 | Reference | Reference | |
<1 | 3.51 (1.79–6.89) | 3.05 (1.57–5.96) | 0.001 |
≥10 | 1.80 (1.29–2.52) | 1.64 (1.15–2.32) | 0.006 |
Male sex | 1.11 (0.84–1.47) | 1.37 (1.05–1.79) | 0.021 |
Immunophenotype | |||
T-cell | Reference | Reference | |
B-cell | 0.79 (0.55–1.15) | 1.37 (0.90–2.08) | 0.14 |
FAB classification | 0.56 (0.31–1.01) | 0.85 (0.46–1.56) | 0.6 |
Initial WBC count (×109/L) | |||
<50 | Reference | Reference | |
50–<100 | 1.47 (0.97–2.23) | 1.59 (1.07–2.36) | 0.022 |
≥100–<200 | 2.45 (1.60–4.61) | 2.04 (1.33–3.14) | <0.001 |
≥200 | 3.04 (2.00–4.61) | 2.71 (1.74–4.21) | <0.001 |
Early complication | 1.16 (0.79–1.71) | 0.88 (0.62–1.26) | 0.5 |
Risk Factor | Crude HR (95% CI) | Adjusted HR (95% CI) | p Value |
---|---|---|---|
Age (years) | |||
1–9 | Reference | Reference | |
<1 | 1.43 (0.80–2.55) | 1.82 (1.00–3.32) | 0.049 |
≥10 | 0.84 (0.59–1.20) | 0.70 (0.48–1.02) | 0.064 |
Male sex | 1.06 (0.77–1.47) | 1.03 (0.74–1.42) | 0.9 |
Initial WBC count (×109/L) | |||
<50 | Reference | Reference | |
50–<100 | 1.13 (0.70–1.82) | 1.25 (0.76–2.03) | 0.4 |
≥100–<200 | 0.83 (0.48–1.43) | 0.81 (0.46–1.44) | 0.5 |
≥200 | 2.16 (1.32–3.53) | 2.63 (1.56–4.43) | <0.001 |
Early complication | 0.83 (0.50–1.40) | 0.89 (0.53–1.50) | 0.7 |
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Kittivisuit, S.; Jongthitinon, N.; Sripornsawan, P.; Songthawee, N.; Chavananon, S.; Limratchapong, C.; McNeil, E.B.; Chotsampancharoen, T. Hyperleukocytosis in Childhood Acute Leukemia: Early Complications and Survival Outcomes. Cancers 2023, 15, 3072. https://doi.org/10.3390/cancers15123072
Kittivisuit S, Jongthitinon N, Sripornsawan P, Songthawee N, Chavananon S, Limratchapong C, McNeil EB, Chotsampancharoen T. Hyperleukocytosis in Childhood Acute Leukemia: Early Complications and Survival Outcomes. Cancers. 2023; 15(12):3072. https://doi.org/10.3390/cancers15123072
Chicago/Turabian StyleKittivisuit, Sirinthip, Nichanan Jongthitinon, Pornpun Sripornsawan, Natsaruth Songthawee, Shevachut Chavananon, Chompoonut Limratchapong, Edward B. McNeil, and Thirachit Chotsampancharoen. 2023. "Hyperleukocytosis in Childhood Acute Leukemia: Early Complications and Survival Outcomes" Cancers 15, no. 12: 3072. https://doi.org/10.3390/cancers15123072