Morbidity profile and outcome of hyperleukocytosis in childhood acute leukemia : experience from a tertiary center

Rachna Seth, Prashant Singh, Kriti Puri, Arushi Arora, Anurag S. Rathore


Hyperleukocytosis is an important cause of morbidity and mortality among acute leukemia patients. The data on hyperleukocytosis from this part of world is scarce. We therefore retrospectively reviewed the clinical and morbidity profile of childhood acute leukemia presenting with total leucocyte count (TLC) >100,000 over a duration of about 2.5 years at our center. Of 140 acute leukemia patients, 24  had hyperleukostasis at presentation. All 24 patients were of lymphoid lineage. The Mean TLC was 193539(+ 92078)/microlitre, and TLC was >200000/microlitre in 16(66.67%) patients. Tumor lysis was present in 12(50%) patients, while superior mediastinal syndrome was present in 4(16.67%). Features of leukostasis were present in 6(25%) patients (2 had neurological involvement, 3 had pulmonary involvement and 1 had features of both pulmonary & neurological stasis). Renal functions were deranged in 5(20.83%) patients. Further, 11(45.8%) patients had hemorrhagic complications. All 24 patients received hyper hydration, sodium bicarbonate and allopurinol. Chemotherapy was initiated once metabolically stable. One patient died during the first induction and four relapsed during follow-up. Childhood acute leukemia with hyperleukocytosis is associated with significant morbidity which can be managed with immediate hospitalization, aggressive management with hyper hydration, allopurinol, alkalinization of the urine and intensive monitoring before beginning chemotherapy.


hyperleukocytosis, ALL, tumor lysis syndrome, superior mediastinal sndrome

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