Emergency therapeutic leukapheresis: A single-center experience in a teaching hospital in Eastern India

Abstract: Hyperleukocytosis is a hematologic crisis caused by excessive proliferation of leukemic cells and has a relatively high early mortality due to a series of severe complications needing prompt and effective interventions. Leukapheresis performed using apheresis equipment to separate leukocytes from peripheral blood at the same time returns autologous plasma, platelets and erythrocytes to the patient and is applied clinically for treatment of hyperleukocytosis with symptoms of leukostasis. The aim of this study is to analyze the safety and effectiveness of therapeutic leukocytapheresis to alleviate symptoms of leukostasis in different types of hematological malignancies. The study is a retrospective review of procedures carried out for the treatment of hyperleukocytosis with symptoms of leukostasis at the Haematology Intensive Care Unit (ICU) and Critical Care ICU by the Transfusion Medicine Department of the institute from February 2019 to April 2024. Eleven patients underwent a total of 12 leukocytapheresis procedures. After an average of 1.09 sessions, a statistically significant drop in the initial leukocyte counts was observed (P = 0.0004), without any significant drop in Hemoglobin g% (P = 0.27%), hematocrit (P = 0.9%) and total platelet count (P = 0.15%). Despite the small size and limited homogeneity of our study, we can conclude that leukocytapheresis is a safe and effective adjuvant therapeutic measure for hematological malignancies, particularly acute lymphoid/myeloid leukemia, chronic myeloid leukemia with hyperleukocytosis and symptoms of leukostasis, especially in a patient who was not appropriate to cytoreduce with Ara-C or hydroxyurea.