Twenty Years of Therapeutic Leukocytapheresis in Newly Diagnosed Acute Myeloid Leukemia: Insights From A Single Center

Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy, and 5%-20% of newly diagnosed patients present with hyperleukocytosis (HL). HL, most often defined as WBC > 100 000/μL, is a hematologic emergency associated with severe complications, early mortality, and poor prognosis, requiring immediate intervention. From November 2005 to September 2025, 65 newly diagnosed AML patients with HL underwent leukocytapheresis (LCP) at University Hospital Olomouc. Clinical data were retrospectively collected from medical records. The primary objective was to evaluate the procedural efficacy and safety. Clinical and laboratory data were analyzed. Survival outcomes were assessed by Kaplan-Meier analysis and compared using the log-rank test. Median age at diagnosis was 57 years. Dyspnea (60.0%), neuropsychiatric symptoms (31.7%), and visual impairment (6.2%) were the most common leukostasis manifestations. LCP effectively reduced WBC counts without significant adverse events, median of 2.2 TBV was treated, and 52.3% of the patients requiring more than one session. FLT3-ITD and NPM1 mutations were detected in 26/46 (56.5%) and 17/43 (39.5%), respectively, KMT2A rearrangements were present in 5/57 (8.8%). Intensive chemotherapy was feasible in 56.9% of patients, with 26.2% undergoing allo-HSCT. Median OS was 5.9 months (95% CI: 1.3-8.4), significantly longer in therapy-eligible patients, but outcomes remained poor, highlighting HL as an unmet clinical need. LCP remains a valuable therapeutic option for patients with HL in newly diagnosed AML. Our long-term experience supports its safety and efficacy, particularly in symptomatic patients, as a bridge to definitive therapy regardless of treatment intensity eligibility.