From the Guidelines
Leukocytosis treatment should be initiated immediately with chemotherapy, such as idarubicin or daunorubicin with cytarabine, even if diagnostic molecular results are pending.
Treatment Approach
- For patients with leukocytosis (WBC count >10^3 10^9/L), chemotherapy should be started without delay, as stated in the expert panel recommendations from the European LeukemiaNet 1.
- Idarubicin or daunorubicin with cytarabine have been the most common chemotherapy-based approaches.
- Hydroxyurea (2-4 g per day) or 1 to 2 doses of idarubicin (12 mg/m2) or gemtuzumab ozogamicin (GO; 6-9 mg/m2) have been used as cytoreductive chemotherapy.
Considerations
- Prophylactic corticosteroids to prevent differentiation syndrome may be considered in patients with a WBC count >5 3 10^9/L to 10 3 10^9/L at presentation or in those showing WBC increase after the start of ATRA, although their benefit remains uncertain 1.
- A pending urinalysis does not affect the initiation of chemotherapy for leukocytosis, as the primary concern is the high WBC count.
- The treatment approach should be based on the patient's clinical presentation and laboratory results, with chemotherapy being the primary treatment for leukocytosis.
From the Research
Leukocytosis Treatment
The treatment for leukocytosis with pending urinalysis is not directly addressed in the provided studies. However, the studies provide information on the diagnosis and interpretation of urinalysis results.
Urinalysis Interpretation
- The sensitivity and specificity of white blood cells (WBC) and nitrite in dipstick urinalysis for detecting urinary tract infections (UTIs) were evaluated in a study 2. The results showed that WBC sensitivity and specificity were 62.7% and 100%, respectively, while nitrite sensitivity and specificity were 20.6% and 93.5%, respectively.
- Another study found that leukocyte esterase and pyuria were the most sensitive indicators of a positive urine culture, with sensitivities of 87.5% and 73.3%, respectively 3.
- A study on women without UTI symptoms found that abnormal urinalysis results were common, regardless of specimen collection technique, and that urine nitrite showed a high specificity 4.
- A review of urinalysis and urinary tract infection update for clinicians found that pyuria is the best determinate of bacteriuria requiring therapy, and that values significant for infection differ depending on the method of analysis 5.
Leukocytosis and Urothelial Carcinoma
- A study found that persistent, unexplained leukocytosis is a paraneoplastic syndrome associated with a poor prognosis in patients with urothelial carcinoma 6. The study found that leukocytosis was frequently associated with hypercalcemia, thrombocytosis, and anemia, and that chemotherapy and extirpative surgery were able to achieve a response in some patients, but that all studied patients ultimately developed leukocytosis recurrence and experienced rapid disease progression.
Pending Urinalysis
In the absence of a confirmed UTI diagnosis, treatment for leukocytosis with pending urinalysis would depend on the underlying cause of the leukocytosis, which may not be related to a UTI. Further evaluation and testing, including urine culture and sensitivity, may be necessary to determine the cause of the leukocytosis and guide treatment.