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- Title
Leukostasis followed by hemorrhage complicating the initiation of chemotherapy in patients with acute myeloid leukemia and hyperleukocytosis: a clinicopathologic report of four cases.
- Authors
Würthner, Jens U.; Köhler, Gabriele; Behringer, Dirk; Lindemann, Albrecht; Mertelsmann, Roland; Lübbert, Michael; Würthner, J U; Köhler, G; Behringer, D; Lindemann, A; Mertelsmann, R; Lübbert, M
- Abstract
<bold>Background: </bold>Pulmonary and cerebral leukostasis, or parenchymal hemorrhage in these organs, are well-known early complications developing in patients with acute myeloid leukemia (AML), particularly when myelomonocytic features, hyperleukocytosis, and/or a coagulation disorder are initially present. Commonly, these complications arise during increasing leukocyte counts (WBCs).<bold>Methods: </bold>The authors describe four patients with AML and hyperleukocytosis who developed leukostasis followed by parenchymal hemorrhage.<bold>Results: </bold>Bleeding in all patients occurred while their WBCs were decreasing following cytosine-arabinoside chemotherapy, and in the absence of disseminated intravascular coagulation or severe thrombocytopenia. Radiologic and histopathologic findings underscoring possible mechanisms are presented in the article.<bold>Conclusions: </bold>Alterations of cell adhesion associated with chemotherapy-induced blast lysis or cellular differentiation are possible factors contributing to this particular sequence (cytosine arabinoside-based chemotherapy, leukostasis, and subsequent hemorrhage). Prophylactic measures for managing this early complication of AML treatment include leukapheresis to reduce the WBC prior to the initiation of chemotherapy.
- Publication
Cancer (0008543X), 1999, Vol 85, Issue 2, p368
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/(SICI)1097-0142(19990115)85:2<368::AID-CNCR14>3.0.CO;2-X