Clinical outcomes of therapeutic leukapheresis in acute promyelocytic leukemia: A single-center retrospective cohort study

Howon Lee; Jae Ho Yoon; Byung Sik Cho; Hee Je Kim; Dong Wook Jekarl; Yonggoo Kim

doi:10.1016/j.jcyt.2023.01.007

Clinical outcomes of therapeutic leukapheresis in acute promyelocytic leukemia: A single-center retrospective cohort study

Howon Lee, Jae Ho Yoon, Byung Sik Cho, Hee Je Kim, Dong Wook Jekarl, Yonggoo Kim

Catholic Univ. of Korea Coll. Med.

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Background: In acute promyelocytic leukemia (APL), increased cell burden in the peripheral blood due to either the disease itself or early treatment with all-trans retinoic acid could cause hyperleukocytosis (HL) before induction chemotherapy. However, therapeutic leukapheresis has seldom been used because of concerns of subsequent coagulopathy after this invasive procedure. The aim of this study was to evaluate the effects of leukapheresis in APL, especially for efficacy and safety. Methods: We retrospectively analyzed newly diagnosed patients with APL from January 2009 to March 2022. Among 323 patients, 85 had white blood cell count above 40 × 10⁹/L before induction chemotherapy. Thirty-nine patients were initially treated with leukapheresis, whereas the other 46 were not. Clinical and laboratory parameters between these groups were compared. Results: There was a trend toward favorable 30-day survival rate for the leukapheresis group compared with the non-leukapheresis group (76.9% and 67.4%; P = 0.24). The complications including subsequent intensive unit care (P = 0.23), severe hemorrhagic events (P = 0.13) showed no significant differences between the two groups. The patients were divided into subcohorts, and the survival rates of the leukapheresis and non-leukapheresis groups were 92.3% (95% confidence interval [CI], 77.8%–100.0%) versus 58.3% (95% CI, 38.6%–78.1%) (P = 0.03) in “sequential HL” and 76.7% (95% CI, 61.5%–91.8%) versus 54.8% (95% CI, 37.3%–72.4%) (P = 0.03) in “symptomatic HL,” respectively. Moreover, in the “sequential HL” subcohort, the cumulative incidence of differentiation syndrome and following adverse events were significantly lower in the leukapheresis group. Conclusions: In APL with “sequential HL” or “symptomatic HL” from either the disease itself or the effect of all-trans retinoic acid, therapeutic leukapheresis could be applied to reduce leukemic cell burden without significant risks.

Original language	English
Pages (from-to)	659-669
Number of pages	11
Journal	Cytotherapy
Volume	25
Issue number	6
DOIs	https://doi.org/10.1016/j.jcyt.2023.01.007
State	Published - Jun 2023

Bibliographical note

Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. H.L. and D.W.J. collected the raw data, designed the study, performed the statistical analyses, interpreted the analysed data, and drafted the article. J.Y. B.C. H.K. treated acute promyelocytic leukemia patients with leukapheresis. Y.K. diagnosed acute promyelocytic leukemia. We thank the apheresis unit staff members for their contributions.

Publisher Copyright:
© 2023 International Society for Cell & Gene Therapy

Keywords

APL
DS
acute promyelocytic leukemia
differentiation syndrome
leukapheresis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jcyt.2023.01.007

Cite this

@article{c345ea9e35574c248ef8df4218bd080a,

title = "Clinical outcomes of therapeutic leukapheresis in acute promyelocytic leukemia: A single-center retrospective cohort study",

abstract = "Background: In acute promyelocytic leukemia (APL), increased cell burden in the peripheral blood due to either the disease itself or early treatment with all-trans retinoic acid could cause hyperleukocytosis (HL) before induction chemotherapy. However, therapeutic leukapheresis has seldom been used because of concerns of subsequent coagulopathy after this invasive procedure. The aim of this study was to evaluate the effects of leukapheresis in APL, especially for efficacy and safety. Methods: We retrospectively analyzed newly diagnosed patients with APL from January 2009 to March 2022. Among 323 patients, 85 had white blood cell count above 40 × 109/L before induction chemotherapy. Thirty-nine patients were initially treated with leukapheresis, whereas the other 46 were not. Clinical and laboratory parameters between these groups were compared. Results: There was a trend toward favorable 30-day survival rate for the leukapheresis group compared with the non-leukapheresis group (76.9% and 67.4%; P = 0.24). The complications including subsequent intensive unit care (P = 0.23), severe hemorrhagic events (P = 0.13) showed no significant differences between the two groups. The patients were divided into subcohorts, and the survival rates of the leukapheresis and non-leukapheresis groups were 92.3% (95% confidence interval [CI], 77.8%–100.0%) versus 58.3% (95% CI, 38.6%–78.1%) (P = 0.03) in “sequential HL” and 76.7% (95% CI, 61.5%–91.8%) versus 54.8% (95% CI, 37.3%–72.4%) (P = 0.03) in “symptomatic HL,” respectively. Moreover, in the “sequential HL” subcohort, the cumulative incidence of differentiation syndrome and following adverse events were significantly lower in the leukapheresis group. Conclusions: In APL with “sequential HL” or “symptomatic HL” from either the disease itself or the effect of all-trans retinoic acid, therapeutic leukapheresis could be applied to reduce leukemic cell burden without significant risks.",

keywords = "APL, DS, acute promyelocytic leukemia, differentiation syndrome, leukapheresis",

author = "Howon Lee and Yoon, {Jae Ho} and Cho, {Byung Sik} and Kim, {Hee Je} and Jekarl, {Dong Wook} and Yonggoo Kim",

note = "Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. H.L. and D.W.J. collected the raw data, designed the study, performed the statistical analyses, interpreted the analysed data, and drafted the article. J.Y. B.C. H.K. treated acute promyelocytic leukemia patients with leukapheresis. Y.K. diagnosed acute promyelocytic leukemia. We thank the apheresis unit staff members for their contributions. Publisher Copyright: {\textcopyright} 2023 International Society for Cell & Gene Therapy",

year = "2023",

month = jun,

doi = "10.1016/j.jcyt.2023.01.007",

language = "English",

volume = "25",

pages = "659--669",

journal = "Cytotherapy",

issn = "1465-3249",

publisher = "Elsevier B.V.",

number = "6",

}

TY - JOUR

T1 - Clinical outcomes of therapeutic leukapheresis in acute promyelocytic leukemia

T2 - A single-center retrospective cohort study

AU - Lee, Howon

AU - Yoon, Jae Ho

AU - Cho, Byung Sik

AU - Kim, Hee Je

AU - Jekarl, Dong Wook

AU - Kim, Yonggoo

N1 - Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. H.L. and D.W.J. collected the raw data, designed the study, performed the statistical analyses, interpreted the analysed data, and drafted the article. J.Y. B.C. H.K. treated acute promyelocytic leukemia patients with leukapheresis. Y.K. diagnosed acute promyelocytic leukemia. We thank the apheresis unit staff members for their contributions. Publisher Copyright: © 2023 International Society for Cell & Gene Therapy

PY - 2023/6

Y1 - 2023/6

N2 - Background: In acute promyelocytic leukemia (APL), increased cell burden in the peripheral blood due to either the disease itself or early treatment with all-trans retinoic acid could cause hyperleukocytosis (HL) before induction chemotherapy. However, therapeutic leukapheresis has seldom been used because of concerns of subsequent coagulopathy after this invasive procedure. The aim of this study was to evaluate the effects of leukapheresis in APL, especially for efficacy and safety. Methods: We retrospectively analyzed newly diagnosed patients with APL from January 2009 to March 2022. Among 323 patients, 85 had white blood cell count above 40 × 109/L before induction chemotherapy. Thirty-nine patients were initially treated with leukapheresis, whereas the other 46 were not. Clinical and laboratory parameters between these groups were compared. Results: There was a trend toward favorable 30-day survival rate for the leukapheresis group compared with the non-leukapheresis group (76.9% and 67.4%; P = 0.24). The complications including subsequent intensive unit care (P = 0.23), severe hemorrhagic events (P = 0.13) showed no significant differences between the two groups. The patients were divided into subcohorts, and the survival rates of the leukapheresis and non-leukapheresis groups were 92.3% (95% confidence interval [CI], 77.8%–100.0%) versus 58.3% (95% CI, 38.6%–78.1%) (P = 0.03) in “sequential HL” and 76.7% (95% CI, 61.5%–91.8%) versus 54.8% (95% CI, 37.3%–72.4%) (P = 0.03) in “symptomatic HL,” respectively. Moreover, in the “sequential HL” subcohort, the cumulative incidence of differentiation syndrome and following adverse events were significantly lower in the leukapheresis group. Conclusions: In APL with “sequential HL” or “symptomatic HL” from either the disease itself or the effect of all-trans retinoic acid, therapeutic leukapheresis could be applied to reduce leukemic cell burden without significant risks.

AB - Background: In acute promyelocytic leukemia (APL), increased cell burden in the peripheral blood due to either the disease itself or early treatment with all-trans retinoic acid could cause hyperleukocytosis (HL) before induction chemotherapy. However, therapeutic leukapheresis has seldom been used because of concerns of subsequent coagulopathy after this invasive procedure. The aim of this study was to evaluate the effects of leukapheresis in APL, especially for efficacy and safety. Methods: We retrospectively analyzed newly diagnosed patients with APL from January 2009 to March 2022. Among 323 patients, 85 had white blood cell count above 40 × 109/L before induction chemotherapy. Thirty-nine patients were initially treated with leukapheresis, whereas the other 46 were not. Clinical and laboratory parameters between these groups were compared. Results: There was a trend toward favorable 30-day survival rate for the leukapheresis group compared with the non-leukapheresis group (76.9% and 67.4%; P = 0.24). The complications including subsequent intensive unit care (P = 0.23), severe hemorrhagic events (P = 0.13) showed no significant differences between the two groups. The patients were divided into subcohorts, and the survival rates of the leukapheresis and non-leukapheresis groups were 92.3% (95% confidence interval [CI], 77.8%–100.0%) versus 58.3% (95% CI, 38.6%–78.1%) (P = 0.03) in “sequential HL” and 76.7% (95% CI, 61.5%–91.8%) versus 54.8% (95% CI, 37.3%–72.4%) (P = 0.03) in “symptomatic HL,” respectively. Moreover, in the “sequential HL” subcohort, the cumulative incidence of differentiation syndrome and following adverse events were significantly lower in the leukapheresis group. Conclusions: In APL with “sequential HL” or “symptomatic HL” from either the disease itself or the effect of all-trans retinoic acid, therapeutic leukapheresis could be applied to reduce leukemic cell burden without significant risks.

KW - APL

KW - DS

KW - acute promyelocytic leukemia

KW - differentiation syndrome

KW - leukapheresis

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U2 - 10.1016/j.jcyt.2023.01.007

DO - 10.1016/j.jcyt.2023.01.007

M3 - Article

C2 - 36774295

AN - SCOPUS:85150337976

SN - 1465-3249

VL - 25

SP - 659

EP - 669

JO - Cytotherapy

JF - Cytotherapy

IS - 6

ER -

Clinical outcomes of therapeutic leukapheresis in acute promyelocytic leukemia: A single-center retrospective cohort study

Abstract

Bibliographical note

Keywords

UN SDGs

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