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Early morbidity and mortality in childhood acute lymphoblastic leukemia with very high white blood cell count

Leukemia volume 27, pages 2259–2262 (2013)Cite this article

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Patients with white blood cell (WBC) count in peripheral blood ⩾200 × 109/l at diagnosis of acute lymphoblastic leukemia (ALL) constitute 5–8% of all childhood ALL patients and are known to have significantly lower survival rates.1, 2 Hyperleukocytosis at diagnosis of childhood ALL is an oncological emergency associated with early morbidity and mortality related both to microcirculatory leukostasis and hyperviscosity and to severe metabolic and electrolyte derangements due to tumor lysis.3, 4 Since the introduction of urate oxidase, the risk of tumor lysis syndrome (TLS) has been markedly reduced.5, 6, 7, 8 However, clinicians may still reduce the dose of anticancer agents or delay the antileukemic therapy to avoid TLS, but the impact of such modifications on the risk of developing of early complications related to hyperleukocytosis and on survival is uncertain.

We performed a population-based multicenter study of 221 children aged 0–14.9 years with ALL and WBC ⩾200 × 109/l at diagnosis treated in Denmark, Finland, Iceland, Lithuania, Norway or Sweden from January 1992 to October 2011. This constituted 92% of all 241 ALL patients with WBC ⩾200 × 109/l during that period, and 6% of all 3985 newly diagnosed ALL patients.

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Acknowledgements

This work was supported by Danish Childhood Cancer Foundation; the University Hospital Rigshospitalet, Copenhagen, Denmark; the Research Council of Lithuania, and the Swedish Childhood Cancer Foundation. Kjeld Schmiegelow holds the Danish Childhood Cancer Foundation research professorship in pediatric oncology.

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Authors and Affiliations

  1. Clinic of Children’s Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    G Vaitkeviciene & L Rageliene

  2. Department for Paediatric and Adolescent Medicine, Juliane Marrie Centre, University Hospital, Rigshospitalet, Copenhagen, Denmark

    G Vaitkeviciene, B Lausen, L Groth-Pedersen & K Schmiegelow

  3. Department of Paediatric Oncology, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden

    M Heyman

  4. Department of Paediatrics, University Hospital Rigshospitalet, Reykjavik, Iceland

    O G Jonsson

  5. Oulu University Hospital, Oulu, Finland

    A Harila-Saari

  6. Department of Paediatrics, Ryhov County Hospital, Jonkoping, Sweden

    M Stenmarker

  7. Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

    M Taskinen

  8. Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania

    T Zvirblis

  9. Paediatric Department, St Olav’s University Hospital, Trondheim, Norway

    A Åsberg

  10. Department of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    K Schmiegelow

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  1. G Vaitkeviciene
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Corresponding author

Correspondence to K Schmiegelow.

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The authors declare no conflict of interest.

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Author Contributions

GV, AHS, AÅ, BL and KS designed the study; GV, MH, OGJ, BL, AHS, MS, MT and AÅ collected data; GV, MH, TZ and KS analyzed data; GV, LR and KS wrote the manuscript. All the authors revised the manuscript and gave their final approval.

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Vaitkeviciene, G., Heyman, M., Jonsson, O. et al. Early morbidity and mortality in childhood acute lymphoblastic leukemia with very high white blood cell count. Leukemia 27, 2259–2262 (2013). https://doi.org/10.1038/leu.2013.137

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