From the Research
Treatment for Leukocytosis of Unknown Etiology
The treatment for leukocytosis of unknown etiology is not straightforward and depends on various factors.
- In cases of hyperleukocytosis, which is defined as a white blood cell count greater than 100,000/μL, the management involves supportive measures and reducing the number of circulating leukemic blast cells by induction chemotherapy, hydroxyurea, low-dose chemotherapy, and leukapheresis 1.
- However, the optimal management of symptomatic hyperleukocytosis is still uncertain, and there are no randomized studies demonstrating one approach is superior to another 1.
- For patients with unexplained or persistent leukocytosis, the approach is more focused on identifying the underlying cause and managing any related complications, rather than treating the leukocytosis itself 2.
- In general, the evaluation of patients with leukocytosis involves using age- and pregnancy-specific normal ranges for the white blood cell count, and considering potential etiologies such as infection, malignancy, and non-malignant conditions 3.
- The management of hyperleukocytosis and leukostasis involves careful monitoring of fluid balance, control of uric acid production, and control of urine pH to prevent tumor lysis syndrome, as well as reducing the number of circulating leukemic blast cells 4.
Key Considerations
- The risk of complications from hyperleukocytosis is higher in acute than in chronic leukemias, and particularly leukostasis occurs more often in acute myeloid leukemia (AML) 5.
- The treatment of hyperleukocytosis should be individualized and based on the specific clinical context, including the presence of symptoms, the underlying diagnosis, and the risk of complications 1, 4, 5.
- Further research is needed to better understand the mechanisms of hyperleukocytosis and leukostasis, and to develop more effective treatments for these conditions 1, 4.