From the Research
The primary treatment approach for leukomoid paraneoplastic reactions involves addressing the underlying malignancy that is triggering the abnormal white blood cell response, as evidenced by the most recent study 1. Successful treatment of the primary cancer—through surgery, chemotherapy, radiation therapy, immunotherapy, or a combination of these modalities—often leads to resolution of the leukomoid reaction. While managing the underlying cancer, supportive care may be necessary to address complications of leukocytosis, such as hydration to prevent hyperviscosity syndrome and thrombosis prophylaxis in high-risk patients. In cases of severe leukocytosis (typically >100,000 cells/μL) with symptoms of leukostasis, temporary cytoreductive therapy with hydroxyurea (starting at 500-1000 mg twice daily, adjusted based on response) may be used until definitive cancer treatment can be initiated, as suggested by previous reports 2, 3. Leukapheresis might be considered in emergent situations with symptoms of leukostasis. Regular complete blood count monitoring is essential to track the response to treatment. The leukomoid reaction occurs because tumor cells produce cytokines and growth factors that stimulate excessive white blood cell production in the bone marrow, so eliminating the source of these factors through cancer treatment is the most effective approach to normalize the white blood cell count, as discussed in the literature 4, 5.
Some key points to consider in the treatment approach include:
- Identifying and treating the underlying malignancy as the mainstay of treatment 2
- Providing supportive care to manage complications of leukocytosis
- Using temporary cytoreductive therapy or leukapheresis in severe cases
- Monitoring complete blood count regularly to track response to treatment
- Understanding the pathophysiology of paraneoplastic leukemoid reaction to guide treatment decisions, as reviewed in the most recent study 1.
It is crucial to prioritize the treatment of the underlying malignancy, as it has the most significant impact on resolving the leukomoid reaction and improving patient outcomes, as highlighted by the latest evidence 1.