Results of a retrospective study demonstrated that leukapheresis plus chemotherapy provided no significant survival benefits in cases of leukostasis in patients with acute myeloid leukemia (AML) compared with chemotherapy only. These study results were published in the Journal of Blood Medicine.
“Whether adding leukapheresis treatment in conjunction with chemotherapy can produce mortality reduction in acute leukemia patients with leukostasis is currently still unclear and contradictory in several studies,” explained the researchers.
The study was conducted at 2 tertiary centers in Indonesia where patients with AML and leukostasis were treated within the years 2007 through 2018. The study’s researchers evaluated 7-day, 14-day, 21-day, and 28-day survival outcomes following treatment with leukapheresis plus chemotherapy or chemotherapy only.
A total of 38 AML patients with leukostasis were evaluated for this analysis. Eleven patients (28.9%) were treated with leukapheresis and chemotherapy; the remaining 27 patients (71.1%) were treated with chemotherapy only. The mean age at baseline was 40.82 years for patients treated with leukapheresis plus chemotherapy and 43.11 years for those treated with chemotherapy only (P =.685).
Median overall survival was 20 days (95% CI, 1.497-38.503) in the leukapheresis group and 25 days (95% CI, 17.001-32.999) in the chemotherapy only group. By 28 days, the mortality rate was 45.5% for patients in the leukapheresis group and 41.7% for patients in the chemotherapy only group.
No significant link was seen between treatment group and cumulative survival rates for 7-day, 14-day, 21-day, or 28-day survival outcomes. For 28-day survival, the hazard ratio (HR) with leukapheresis plus chemotherapy, compared with chemotherapy only, was 1.140 (95% CI, 0.396-3.283; P =.809). For 7-day survival, the HR for this treatment comparison was 1.073 (95% CI, 0.277-4.152; P =.919).
In a multivariate analysis, factors associated with poorer 28-day survival included a creatinine level of 1.4 mg/dL or higher (P =.003), the presence of disseminated intravascular coagulation (P =.004), blast percentage 90% or higher (P =.013), and age 60 years or older (P =.046).
Leukapheresis carries a procedural risk and does not remove blast cells from bone marrow, which may contribute to risk of short-term relapse. “Hence, we do not recommend the addition of leukapheresis for AML patients with leukostasis, as its use together with chemotherapy does not provide better survival when compared with chemotherapy only, and there are many disadvantages of leukapheresis,” the researchers wrote.
Rinaldi I, Sari RM, Tedhy VU, Winston K. Leukapheresis does not improve early survival outcome of acute myeloid leukemia with leukostasis patients — a dual-center retrospective cohort study. J Blood Med. 2021;12:623-633. doi:10.2147/JBM.S312140