From the Guidelines
White blood cell counts in leukemia can increase extremely rapidly, sometimes doubling within days or even hours in aggressive forms of the disease, as seen in acute leukemias like Acute Lymphoblastic Leukemia (ALL) 1.
Key Points to Consider
- Acute leukemias like ALL can cause white blood cell counts to rise from normal levels (4,000-11,000 cells/μL) to over 100,000 cells/μL within a week or two.
- In hyperleukocytosis, a medical emergency, counts may exceed 100,000 or even 200,000 cells/μL, requiring immediate treatment with chemotherapy agents like hydroxyurea, cytarabine, or leukapheresis to rapidly reduce the count.
- The rapid proliferation of leukemic cells occurs because they lose normal growth regulation mechanisms and multiply uncontrollably, crowding out healthy blood cells and potentially causing symptoms like fatigue, bleeding, infections, and organ damage from blood hyperviscosity.
Treatment Approach
- The treatment approach to ALL represents one of the most complex and intensive programs in cancer therapy, with the most common treatment regimens including modifications or variations of multiagent therapy regimens originally developed by the Berlin-Frankfurt-Münster group for pediatric patients 1.
- Induction regimens for adult ALL are also based on a backbone of vincristine, corticosteroids, and anthracyclines, with the goal of rapidly reducing the white blood cell count and achieving complete remission.
Recent Guidelines and Recommendations
- The NCCN Guidelines for ALL focus on the treatment of newly diagnosed Philadelphia chromosome (Ph)-negative B-cell ALL (B-ALL) in adults, with recommendations for induction, consolidation, and maintenance therapy 1.
- The guidelines emphasize the importance of prompt institution of definitive therapy and the use of targeted agents and allogeneic hematopoietic cell transplantation (HCT) to improve cure rates and survival outcomes for patients with ALL.
From the Research
Leukemia and White Cell Count
- Leukemia is a clonal proliferation of hematopoietic stem cells in the bone marrow, which can lead to an abnormal increase in white blood cell count 2.
- The rate of increase in white cell count can vary depending on the subtype of leukemia, with acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML) often presenting with higher white blood cell counts than chronic lymphocytic leukemia (CLL) and chronic myelogenous leukemia (CML) 3, 4.
- A complete blood count (CBC) is usually performed to diagnose leukemia, which can reveal leukocytosis (elevated white blood cell count) and other abnormal cell lines 2, 5.
Diagnostic Evaluation
- The diagnostic evaluation of acute leukemia requires a combination of clinical information, morphologic evaluation, immunophenotyping, karyotype analysis, and molecular genetic testing 5.
- A guideline for the diagnostic evaluation of acute leukemia has been developed by the College of American Pathologists and the American Society of Hematology, which provides recommendations for laboratory testing and reporting 5.
Treatment and Prognosis
- Treatment for leukemia may include chemotherapy, radiation, targeted molecular therapy, monoclonal antibodies, or hematopoietic stem cell transplantation, depending on the subtype and stage of the disease 2, 3, 4.
- The prognosis for leukemia patients varies depending on the subtype, age, and other factors, with five-year survival rates highest in younger patients and those diagnosed with CML or CLL 2, 4.