Leukapheresis for the management of hyperleukocytosis in acute myeloid leukemia-A systematic review and meta-analysis.
Journal
Transfusion
ISSN: 1537-2995
Titre abrégé: Transfusion
Pays: United States
ID NLM: 0417360
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
27
05
2020
accepted:
15
06
2020
pubmed:
11
8
2020
medline:
30
6
2021
entrez:
11
8
2020
Statut:
ppublish
Résumé
Up to 20% of patients with acute myeloid leukemia (AML) present with hyperleukocytosis, usually defined as a white blood cell (WBC) count greater than 100 × 10 For this systematic review and meta-analysis we searched MEDLINE and EMBASE via Ovid, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from inception through March 2020 for multiarm studies comparing early mortality rates of patients with AML treated with leukapheresis and those who were not. The risk ratio (RR) of early death for patients who received leukapheresis vs patients who did not was estimated using a sum of the log-ratio of individual study estimates weighted by sample size. Among 13 two-arm, retrospective studies with 1743 patients (486 leukapheresis and 1257 nonleukapheresis patients), leukapheresis did not improve the primary outcome of early mortality compared to treatment strategies in which leukapheresis was not used (RR, 0.88; 95% confidence interval [CI], 0.69-1.13; P = .321) without statistically significant heterogeneity between studies (Cochran's Q, 18; P = .115; I As we did not find evidence of a short-term mortality benefit and considering the associated complications and logistic burden, our results argue against the routine use of leukapheresis for hyperleukocytosis among patients with AML.
Sections du résumé
BACKGROUND
Up to 20% of patients with acute myeloid leukemia (AML) present with hyperleukocytosis, usually defined as a white blood cell (WBC) count greater than 100 × 10
STUDY DESIGN AND METHODS
For this systematic review and meta-analysis we searched MEDLINE and EMBASE via Ovid, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from inception through March 2020 for multiarm studies comparing early mortality rates of patients with AML treated with leukapheresis and those who were not. The risk ratio (RR) of early death for patients who received leukapheresis vs patients who did not was estimated using a sum of the log-ratio of individual study estimates weighted by sample size.
RESULTS
Among 13 two-arm, retrospective studies with 1743 patients (486 leukapheresis and 1257 nonleukapheresis patients), leukapheresis did not improve the primary outcome of early mortality compared to treatment strategies in which leukapheresis was not used (RR, 0.88; 95% confidence interval [CI], 0.69-1.13; P = .321) without statistically significant heterogeneity between studies (Cochran's Q, 18; P = .115; I
CONCLUSION
As we did not find evidence of a short-term mortality benefit and considering the associated complications and logistic burden, our results argue against the routine use of leukapheresis for hyperleukocytosis among patients with AML.
Identifiants
pubmed: 32776542
doi: 10.1111/trf.15994
pmc: PMC8631180
mid: NIHMS1731546
doi:
Substances chimiques
Hydroxyurea
X6Q56QN5QC
Types de publication
Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2360-2369Subventions
Organisme : NCI NIH HHS
ID : T32 CA009512
Pays : United States
Organisme : NIH HHS
ID : P30 CA016359
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA016359
Pays : United States
Organisme : NIH HHS
ID : P30 CA008748
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 AABB.
Références
J Formos Med Assoc. 2014 Nov;113(11):833-8
pubmed: 24534017
Transfus Apher Sci. 2018 Feb;57(1):4-7
pubmed: 29477941
Haematologica. 2012 Nov;97(11):1770-3
pubmed: 22801969
Haematologica. 2020 Jan;105(1):102-111
pubmed: 31004015
Blood. 2012 Sep 6;120(10):1993-2002
pubmed: 22700723
Br J Haematol. 1997 Aug;98(2):433-6
pubmed: 9266944
Leuk Lymphoma. 2017 Sep;58(9):1-11
pubmed: 28140714
Transfus Apher Sci. 2017 Dec;56(6):880-882
pubmed: 29153308
Transfusion. 2007 Oct;47(10):1843-50
pubmed: 17880610
Cancer. 2008 Aug 1;113(3):522-9
pubmed: 18484648
Leuk Res. 2014 Apr;38(4):460-8
pubmed: 24472688
Am J Hematol. 2007 Nov;82(11):976-80
pubmed: 17636473
Br J Haematol. 2015 Feb;168(3):384-94
pubmed: 25303497
Transfusion. 2018 Jan;58(1):208-216
pubmed: 28960357
J Natl Compr Canc Netw. 2019 Jun 1;17(6):721-749
pubmed: 31200351
J Epidemiol Community Health. 1998 Jun;52(6):377-84
pubmed: 9764259
Ann Hematol. 2015 Dec;94(12):2067-8
pubmed: 26255280
Blood. 2015 May 21;125(21):3246-52
pubmed: 25778528
Am J Hematol. 1988 Jan;27(1):34-7
pubmed: 3162645
Leuk Lymphoma. 2001 Jun;42(1-2):67-73
pubmed: 11699223
Leukemia. 2020 Dec;34(12):3149-3160
pubmed: 32132655
JAMA. 2000 Apr 19;283(15):2008-12
pubmed: 10789670
Leuk Lymphoma. 2018 Nov;59(11):2723-2726
pubmed: 29667455
Expert Rev Hematol. 2020 May;13(5):489-499
pubmed: 32248712
Blood. 2017 Jan 26;129(4):424-447
pubmed: 27895058
J Clin Apher. 2019 Jun;34(3):171-354
pubmed: 31180581
Leuk Lymphoma. 2020 May;61(5):1220-1225
pubmed: 32100599
PLoS One. 2014 Apr 14;9(4):e95062
pubmed: 24733550
Leuk Lymphoma. 2016 Oct;57(10):2281-8
pubmed: 26849624