From the Guidelines
Treatment for chronic elevated white blood cell count (leukocytosis) should prioritize identifying and addressing the underlying cause, with a focus on targeted therapies such as imatinib, dasatinib, or nilotinib for hematologic malignancies like chronic myeloid leukemia, as recommended by the most recent European LeukemiaNet guidelines 1.
Key Considerations
- A thorough medical evaluation, including complete blood count with differential, peripheral blood smear, and possibly bone marrow examination, is necessary to determine the underlying cause of leukocytosis.
- For reactive causes like chronic infection, treatment focuses on resolving the infection with appropriate antibiotics.
- For inflammatory conditions, anti-inflammatory medications or immunomodulators like prednisone, methotrexate, or biologics may be prescribed.
- For hematologic malignancies, targeted therapies such as imatinib (400 mg daily), dasatinib, or nilotinib may be indicated, as supported by studies like 1 and 1.
- Regular monitoring of blood counts and adjustment of therapy based on response and tolerance are essential components of management.
Management of High WBC
- When patients present with very high WBC, leukostasis with resultant tissue damage can occur, and management of symptomatic leukostasis is crucial, as noted in 1.
- Hydroxyurea (starting at 500-1000 mg daily) may be used to reduce cell counts in patients with myeloproliferative disorders, as mentioned in 1.
Prioritizing Morbidity, Mortality, and Quality of Life
- The goal of treatment is not just to normalize the WBC count but to treat the underlying condition causing the elevation, with a focus on improving morbidity, mortality, and quality of life, as emphasized in 1.
From the Research
Chronic Elevated WBC Treatment
- The treatment of chronic elevated white blood cell (WBC) count depends on the underlying cause, which can be malignant or non-malignant 2.
- Non-malignant causes of leukocytosis include infections, inflammatory conditions, certain medications, asplenia, smoking, obesity, and chronic inflammatory conditions 2, 3.
- Malignant causes of leukocytosis, such as chronic myeloid leukemia (CML), require specific treatment, including tyrosine kinase inhibitors (TKIs) 4, 5, 6.
- The choice of TKI depends on various factors, including disease risk, potency, and toxicity profile of each TKI, as well as patient comorbidities and preferences 6.
- Treatment options for CML include imatinib, dasatinib, nilotinib, and bosutinib, with imatinib being the first-line treatment 4, 6.
- Allogeneic stem cell transplant is still the only proven curable treatment for CML in patients with an appropriate donor 4, 5.
- In some cases, TKIs can be safely discontinued in select individuals who have maintained deep responses for extended periods, establishing treatment-free remission as a novel goal in CML 6.
- It is essential to evaluate patients with leukocytosis using age- and pregnancy-specific normal ranges for WBC count and to consider other signs and symptoms of infection or malignancy 2, 3.