白细胞分离术在高白细胞急性白血病中的临床应用

目的观察白细胞分离术对高白细胞急性白血病（hyperleukocytic acute leukemia,HAL）白细胞淤滞临床症状及疾病转归的影响。方法回顾性分析66例HAL患者病例资料,观察白细胞分离术对外周血白细胞绝对计数、白细胞淤滞症状、早期病死率、1周期化学治疗完全缓解（complete remission,CR）率、2周期化学治疗后总CR率、总生存期（overall survival,OS）的影响。结果分离组患者白细胞分离后白细胞计数差异有统计学意义（P=0.000）,患者白细胞计数降至20×109/L时间,分离组短于未分离组（P=0.011）。对于白细胞淤滞所致的I型呼吸衰竭和中枢神经系统症状,分离组患者改善率高于未分离组（P〈0.05）。白细胞分离组与未分离组早期病死率差异无统计学意义（P=1.000）,白细胞分离术对于HAL患者的1周期化学治疗后CR率、2周期化学治疗CR率及OS无影响（P〉0.05）。结论白细胞分离术联合小剂量化学治疗药物较单纯小剂量化学治疗可以较快地降低HAL患者外周血的白细胞计数,更好地改善HAL患者白细胞淤滞所致的I型呼吸衰竭和中枢神经系统症状。白细胞分离术并未改善HAL患者早期病死率,化学治疗后CR率及OS。

Clinical application of leukapheresis in patients with hyperleukocytic acute leukemia

Objective To determine whether leukapheresis has a favorable impact on hyperleukocytic acute leukemia（ HAL） patients with leukostasis,and it has any effects on the disease outcomes of these patients. Methods Clinical data of 66 hyperleukocytic acute leukemia patients were collected. The impact of leukapheresis on leukostasis and peripheral white blood cell count were retrospectively analyzed. Clinical outcomes such as early mortality,complete remission（ CR） rate and overall survival（ OS） rate were also accessed.Results Leukapheresis can reduce the peripheral WBC count of HAL patients（ P = 0. 000）. The time to WBC count declined to 20 ×109/L in the group with leukapheresis was significantly shorter than that in the group without leukapheresis（ P = 0. 011）. As to type I respiratory failure and central nervous system symptoms caused by leukostasis,a significant improvement was revealed in leukapheresis group（ P 〈0. 05）. There was no significant difference in early mortality between the two groups（ P = 1. 000）. The differences in complete relief（ CR） rate after the first cycle of induction chemotherapy,CR rate after the second cycle and overall survival between the two groups were not observed（ P 〉0. 05）. Conclusion Leukapheresis and low-dose chemotherapy could quickly reduce the peripheral WBC counts of HAL patients,and improve type I respiratory failure and central nervous system symptoms due to leukostasis.Leukapheresis did not improve early mortality,CR rate after the first cycle of induction chemotherapy,CR rate after the second cycle and OS of HAL patients.