The impact of leukapheresis and chemotherapy on early mortality in adult acute myeloid leukemia with hyperleukocytosis: Single center experience in Indonesia

Background: Hyperleukocytosis (HL) is associated with high rates of morbidity and early mortality of up to 29 due to the development of leukostasis, tumor lysis syndrome (TLS), and disseminated intravascular coagulopathy (DIC) in adult acute myeloid leukemia (AML). The treatment options include chemotherapy, steroids, and leukapheresis. Leukapheresis has a beneficial effect on chemotherapy, but clinical trials showed controversy. We aimed to evaluate the effect of adding leukapheresis to chemotherapy on 30-day survival in AML patients with HL. Methods: The study design was as a retrospective cohort study using secondary data from medical records collected between July and August 2024. Inclusion criteria were ages of 18 years and older, diagnosed with AML with a leukocyte count greater than 100,000/mm³ admitted to our hospital between January 2019 and July 2024, and received chemotherapy with and without leukapheresis. The primary endpoint is a 30-day survival rate since admission to the hospital. The Kaplanâ��Meier (log-rank) curve method was used for mortality between leukapheresis concomitant with chemotherapy (Group A) and chemotherapy only (Group B). Bivariate analysis is used to analyze correlations between mortality and clinical parameters. Results: We identified 50 patients with 25 patients in each group. Group A showed a significantly higher leukocyte count (222 vs. 172.000/mm³ p = 0.031) and a larger proportion of leukostasis (80 vs. 37.5 , p = 0.002). The median overall survival in group A was 20 days (95 confidence interval/CI: 17.178-22.822), while in group B 19 days (95 CI: 8.394-29.606). By day 30, 72 of patients in group A had died, compared to 84 in group B. Kaplan-Meier analysis with log-rank test for 30 days of mortality showed an insignificant difference between the two groups with p log-rank: 0.352. In the bivariate analysis, age showed a significant negative correlation with the survival (r: 0.462, p = 0.001). Conclusion: In our study, we showed a comparable 30-day survival of AML patients with HL receiving leukapheresis and chemotherapy and those treated with chemotherapy only. It indicated that leukapheresis reversed the poorer survival of group A to a similar level as group B. Older age was the only prognostic factor for unfavorable 30-day survival. © 2025