Title: Management of Pediatric Chronic Myeloid Leukemia: Experience from Eastern India
Abstract: acute complications pertaining to hyperleukocytosis in pediatric acute leukemia patients prior to free availability of rasburicase, and without leucopheresis.Method: Records of pediatric acute leukemia patients and "very high" leucocytosis (VHL) (WBC > 100,000/mm 3 in AML and > 200,000/mm 3 in ALL) were analyzed.None of these patients received rasburicase and /or leucopheresis.Patients were managed with allopurinol and aggressive hydration.Data was analyzed for baseline presentation, TLS and other complications pertaining to leucostasis.Results: Out of 457 pediatric acute leukemia patients from Jun 2003-Dec 2009, there were 45 (10%) patients with VHL.Median age was 10 years (SD-4.4;range 3-18) and male: female ratio was 6.5:1.B-ALL, T-ALL and AML constituted 11 (24.4%),16 (35.5%)and 18 (39.9%)patients respectively.Mean baseline WBC for ALL and AML patients was 296,500/mm 3 (SD-104,793; range 200,000-615,220) and 206,300/mm 3 (SD-110,000; range 106,100-541,900) respectively.Laboratory TLS was seen in 17 (37.7%)patients [ 2 (4.4%) at baseline while 15 (33.3%) patients developed it after chemotherapy initiation].Clinical TLS was observed in 6 (13.3%) and renal dysfunction in 7 (15.5%)patients; none required dialysis.CR was achieved in 32 (71.1%) pts and there were 3 (6.6%)deaths.No relation was seen between laboratory TLS and baseline features or mortality.Thrombocytopenia below median (<31,000/ mm 3 ) was associated with mortality ( p = 0.03); hypolabuminia <3.5g/Dl was associated with hypocalcemia ( p = 0.004) and kidney dysfunction ( p = 0.04).Conclusion: Although TLS is common in this "very high" risk group of pediatric leukemias, yet a good outcome with respect to acute complications is possible with proper hydration and allopurinol without rasburicase and leucopheresis.VHL with thrombocytopenia is a risk factor for mortality.