Die Therapeutische Leukozytapherese ist effektiver in Patienten mit AML als in Patienten mit CML – die Single-Center Erfahrung
Patricija Rajsp (Wien / AT), Nina Worel (Wien / AT), Manuela Branka (Wien / AT), Markus Dettke (Wien / AT), Michaela Horvath (Wien / AT), Vera Kolovratova (Wien / AT), Martin Kurz (Wien / AT), Andreas Tanzmann (Wien / AT), Alexander Tolios (Wien / AT), Verena Nunhofer (Wien / AT), Stephanie Winter (Wien / AT), Antonia MS Müller (Wien / AT)
Therapeutic leukocytapheresis is used to rapidly decrease excessive white blood cell (WBC) counts in patients with acute or chronic leukemia and leukostasis syndrome. This study aims to compare the effectiveness of leukocytapheresis among different patient groups and also evaluates the role of hydroxyethyl starch (HES) in apheresis efficiency. Specifically, our research focuses on comparison between myeloid and lymphoblastic diseases.
We retrospectively analyzed first leukocytapheresis procedures in 58 consecutive patients, performed between January 2016 and April 2024. Patients were diagnosed with acute myeloid (AML, n=38), chronic myeloid (CML, n=10), acute lymphoblastic (ALL, n=6), chronic myelomonocytic (CMML, n=1), chronic lymphocytic (CLL, n=1), and T prolymphocytic leukemia (T-PLL, n=2). We assessed the median WBC reduction rate and analyzed the influence of HES as sedimentation aid on the depletion efficiency (Table 1 and 2).
Statistical significance was determined using the Mann-Whitney U test, with a threshold p-value of
Leukocyte depletion was tolerated well in all patients. Comparing myeloid versus lymphoblastic leukemia patients, no significant difference was found in median WBC precounts (192 vs. 308.5; p=0.17) and WBC reduction rates (49.2 vs. 47.7%; p=0.89). However, patients with AML showed higher WBC reduction rates compared to CML (54.4 vs. 30.3%, p=0.002) and CML patients had higher WBC precounts (459 vs. 175; p<0.001). Patients with multiple leukocytaphereses had higher WBC precounts (276.1 vs. 163.3; p<0.001), and the use of HES (45% of CML and 18% of AML cases) had a significant effect on the WBC reduction in AML but not in CML patients. However, HES did not influence the need for a second leukocytapheresis, irrespective of disease entity.
Our study highlights the efficacy of therapeutic leukocytapheresis in managing hematological disorders, demonstrating a better WBC reduction in AML patients compared to CML patients. AML patients also benefited more from the use of HES than CML patients. Cases with multiple leukocytaphereses had higher WBC precounts, emphasizing the need for repeated interventions in excessive hyperleukocytosis.
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