Efficacy of Therapeutic Leukapheresis in Acute Lymphoblastic Leukemia Presenting with Leukostasis

Therapeutic leukapheresis is performed in patients having hyperleukocytosis, leading to leukostasis. The aim of this study was to evaluate the efficacy of therapeutic leukapheresis in reducing white cell count in leukemic patients with symptoms of leukostasis. Two cases of acute lymphoblastic leukemia, admitted to the hematology intensive care unit between January and May 2015, were taken up for therapeutic leukapheresis, using COBE Spectra Cell Separator. The first patient was a 24-year-old male, admitted with fever, weakness, headache, blurred vision, and a total leukocyte count (TLC) of 564,000/μL. The second patient was a 36-year-old male admitted with fever, headache, dyspnea, and a TLC of 530,000/μL. The first patient had a 31.38% and 30.19% reduction in TLC after first and second procedures, respectively. The second patient had a reduction in TLC of 31.7% and 31.41% after first and second procedures, respectively. This significant decrease in white cell count achieved reversal of symptoms of leukostasis. Patients with hyperleukocytosis may present as a medical emergency, requiring prompt recognition and initiation of therapy to prevent respiratory failure or intracranial hemorrhage. Leukapheresis removes circulating blasts quickly to alleviate symptoms.