Demographics, clinical characteristics, and treatment components of patients with extreme hyperleukocytosis at presentation
| Characteristic . | Number of patients (%) . | Median (range) . |
|---|---|---|
| Total cohort | 37 (100) | |
| Age (y) | 37 (100) | 43 (1-73) |
| Sex | ||
| Male | 16 (43) | |
| Female | 21 (57) | |
| WBC count (×109/L) | 37 (100) | 124.0 (96.7-297.0) |
| Platelet count (×109/L) | 34 (92) | 33 (5-92) |
| Hemoglobin (g/L) | 34 (92) | 100 (36-142) |
| Fibrinogen (g/L) | 34 (92) | 1.3 (0.2-5.4) |
| D-dimers (mg/L)∗ | 22 (59) | 8.0 (>0.08-74.8) |
| Hemorrhagic manifestations | ||
| Yes† | 26 (70) | |
| No | 9 (24) | |
| Unknown | 2 (5) | |
| Thrombotic manifestations | ||
| Yes‡ | 8 (22) | |
| No | 26 (70) | |
| Unknown | 3 (8) | |
| Karyotype | ||
| t(15;17) only | 25 (68) | |
| t(15;17) + additional abnormalities | 3 (8) | |
| FISH only | 1 (3) | |
| Normal | 1 (3) | |
| Unknown | 7 (19) | |
| PML breakpoint | ||
| bcr1/2 | 10 (27) | |
| bcr3 | 19 (51) | |
| Unknown | 8 (22) | |
| FLT3 ITD | ||
| Yes | 11 (30) | |
| No | 4 (11) | |
| Unknown | 22 (59) | |
| FLT3 TKD | ||
| Yes | 1 (3) | |
| No | 12 (32) | |
| Unknown | 24 (65) | |
| Presentation | ||
| Early (>10 years before analysis) | 15 (41) | |
| Late (<10 years before analysis) | 22 (59) | |
| Induction | ||
| ATRA + anthracycline + cytarabine and/or hydroxyurea | 13 (35) | |
| ATRA + anthracycline | 12 (32) | |
| ATRA + anthracycline + ATO + cytarabine and/or hydroxyurea | 7 (19) | |
| ATRA + anthracycline + ATO | 4 (11) | |
| ATRA + hydroxyurea | 1 (3) | |
| Consolidation | ||
| ATRA + chemotherapy | 14 (50) | |
| ATRA + ATO | 13 (46) | |
| ATRA + ATO + chemotherapy | 1 (4) | |
| Maintenance | ||
| ATRA + 6MP + MTX | 12 (100) | |
| ATRA + ATO | 0 (0) |
| Characteristic . | Number of patients (%) . | Median (range) . |
|---|---|---|
| Total cohort | 37 (100) | |
| Age (y) | 37 (100) | 43 (1-73) |
| Sex | ||
| Male | 16 (43) | |
| Female | 21 (57) | |
| WBC count (×109/L) | 37 (100) | 124.0 (96.7-297.0) |
| Platelet count (×109/L) | 34 (92) | 33 (5-92) |
| Hemoglobin (g/L) | 34 (92) | 100 (36-142) |
| Fibrinogen (g/L) | 34 (92) | 1.3 (0.2-5.4) |
| D-dimers (mg/L)∗ | 22 (59) | 8.0 (>0.08-74.8) |
| Hemorrhagic manifestations | ||
| Yes† | 26 (70) | |
| No | 9 (24) | |
| Unknown | 2 (5) | |
| Thrombotic manifestations | ||
| Yes‡ | 8 (22) | |
| No | 26 (70) | |
| Unknown | 3 (8) | |
| Karyotype | ||
| t(15;17) only | 25 (68) | |
| t(15;17) + additional abnormalities | 3 (8) | |
| FISH only | 1 (3) | |
| Normal | 1 (3) | |
| Unknown | 7 (19) | |
| PML breakpoint | ||
| bcr1/2 | 10 (27) | |
| bcr3 | 19 (51) | |
| Unknown | 8 (22) | |
| FLT3 ITD | ||
| Yes | 11 (30) | |
| No | 4 (11) | |
| Unknown | 22 (59) | |
| FLT3 TKD | ||
| Yes | 1 (3) | |
| No | 12 (32) | |
| Unknown | 24 (65) | |
| Presentation | ||
| Early (>10 years before analysis) | 15 (41) | |
| Late (<10 years before analysis) | 22 (59) | |
| Induction | ||
| ATRA + anthracycline + cytarabine and/or hydroxyurea | 13 (35) | |
| ATRA + anthracycline | 12 (32) | |
| ATRA + anthracycline + ATO + cytarabine and/or hydroxyurea | 7 (19) | |
| ATRA + anthracycline + ATO | 4 (11) | |
| ATRA + hydroxyurea | 1 (3) | |
| Consolidation | ||
| ATRA + chemotherapy | 14 (50) | |
| ATRA + ATO | 13 (46) | |
| ATRA + ATO + chemotherapy | 1 (4) | |
| Maintenance | ||
| ATRA + 6MP + MTX | 12 (100) | |
| ATRA + ATO | 0 (0) |
ATO, arsenic trioxide; ATRA, all-trans retinoic acid; FISH, fluorescence in situ hybridization; ITD, internal tandem duplication; MTX, methotrexate; TKD, tyrosine kinase domain mutation; 6MP, 6-mercaptopurine.
The median D-dimer is an approximation only and can be regarded as a minimum figure because some laboratories quoted results as greater than a particular threshold rather than providing a specific figure.
Sites of bleeding were intracranial (10, including intracerebral, subdural and subarachnoid), cutaneous (9, including bruising and bleeding from puncture sites), mucosal (7, including epistaxis, gastrointestinal, and urinary tract), intraocular or peri-orbital bleeding (3), intrapulmonary (1), and site not specified (1).
Sites of thromboses included intracerebral (3), deep venous thrombosis (1), superficial venous thrombosis (1), hepatic vein (1), pulmonary embolism (2), subclavian artery (1), and digital necrosis (1).