Clinical Outcomes and Prognostic Factors in AML with Hyperleukocytosis: A Multicenter Real-World Study
UHOD - Uluslararasi Hematoloji-Onkoloji Dergisi, cilt.35, sa.3, ss.212-220, 2025 (SCI-Expanded, Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 35 Sayı: 3
- Basım Tarihi: 2025
- Doi Numarası: 10.4999/uhod.258381
- Dergi Adı: UHOD - Uluslararasi Hematoloji-Onkoloji Dergisi
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.212-220
- Anahtar Kelimeler: Acute myeloid leukemia, Hyperleukocytosis, Early mortality, Overall survival, Clinical leukostasis
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Hyperleukocytosis, defined as a white blood cell (WBC) count exceeding 100x109/L, is a life-threatening complication in acute myeloid leukemia (AML) and is associated with early mortality (EM) and poor outcomes. This multicenter retrospective study included 58 newly diagnosed adult AML patients with hyperleukocytosis. Clinical features and survival outcomes were analyzed. The median age at diagnosis was 55 years, with 24.1% of patients aged above 65. Clinical leukostasis (CL) was observed in 48.3%. FLT3 and NPM1 mutations were present in 56.8% and 44.8% of patients, respectively. Overall, 22% experienced EM, and the median overall survival (OS) was 15.0 months. Intensive induction chemotherapy was administered in 77.3% of cases, with a composite complete remission (CR + CRi) rate of 80.5% compared to 45.5% in patients receiving low-intensity therapy (p= 0.020). In multivariate analysis, age > 65 years was the only independent predictor of EM (OR: 10.05; p= 0.035), while both advanced age and poor ECOG performance status (2-3) were independently associated with inferior OS (HR: 2.59 and 3.26, respectively). Leukapheresis, performed in all patients with CL, was not associated with improved survival outcomes. The interval between cytoreduction and induction therapy initiation did not significantly affect EM or OS. Hyperleukocytic AML continues to pose a high risk of early death, particularly among elderly patients. Advanced age remains the most powerful predictor of adverse outcomes. Given the acute clinical complexity and poor outcomes in this high-risk group, prospective trials are urgently needed to guide evidence-based, standardized management approaches.