tu백혈구증가증치료에서의 백혈구성분채집술 - 단일 상급 종합병원의 10년간 경험 = Therapeutic Leukapheresis for the Management of Hyperleukocytosis: Ten-year Experience in a Tertiary Care Hospital

다국어 초록 (Multilingual Abstract)

Background: Hyperleukocytosis is a medical emergency that is characterized by increased blood viscosity and predisposition to various neurological, pulmonary, and gastrointestinal complications. In addition, patients are at risk of the tumor lysis syndrome because of the increased tumor burden. Therapeutic leukapheresis is an important treatment for these emergent states. In this study, we retrospectively analyzed therapeutic leukapheresis procedures that were performed in our institution during the last 10 yr.
Methods: We retrospectively analyzed therapeutic leukapheresis procedures conducted from July 2005 to March 2015 at a tertiary care hospital. We present our observations, especially the procedural characteristics and hematological parameters before and after the aforementioned procedures.
Results: Seventy-two patients underwent a total of 146 therapeutic leukapheresis procedures. The average presenting white blood cell (WBC) count was 268×103/μL, and ranged from 54×103/μL to 673×103/μL. After an average of two sessions, a statistically significant drop in the WBC counts was observed. The average WBC removal rates during the initial and entire therapeutic leukapheresis procedures of each patient were 33% and 46%, respectively. The platelet count and hemoglobin concentration were significantly reduced.
Conclusions: Therapeutic leukapheresis significantly reduces peripheral WBC counts and is a safe and effective procedure for the treatment of hyperleukocytosis.

국문 초록 (Abstract)

배경: 백혈구증가증은 혈액의 점도를 증가시켜 다양한 신경, 폐, 위장관계의 합병증을 유발할 수 있는 내과적 응급상황이다. 또한,종양 부담의 증가로 인해 종양용해증후군이 발생할 위험이 있다. 치료적 백혈구성분채집술은 이러한 응급 상황에서 치료 방법의 하나로 고려될 수 있다. 이번 연구에서는 본 기관에서 10년간 시행된 치료적 백혈구성분채집술을 후향적으로 분석하였다.
방법: 2005년 7월부터 2015년 3월까지 일개 3차 의료기관에서 시행된 치료적 백혈구성분채집술에 대하여 술식과 관련된 특성 및 시술 전후의 혈액학적 지표의 변화를 분석하였다.
결과: 72명의 환자에서 총 146회의 치료적 백혈구성분채집술이 시행되었다. 대상 환자의 최초 내원 당시의 백혈구 수는 평균 268×103/L로, 54×103/L에서 673×103/L까지 분포하였다. 평균 2회의 시술을 시행 후 백혈구 수는 통계학적으로 유의하게 감소하였다. 대상 환자의 최초 1회의 치료적 백혈구성분채집술과 전체의 치료적 백혈구성분채집술에 의하여 백혈구 수는 각각 33%, 46%가 감소하였다. 혈소판 수와 혈색소 수치 역시 유의하게 감소하였다.
결론: 치료적 백혈구성분채집술은 말초혈액의 백혈구 수를 유의하게 감소시키며, 시술 중 특별한 부작용은 관찰되지 않아 백혈구증가증 치료의 안전하고 효과적인 술식으로 판단된다.

참고문헌 (Reference)

1 채명종, "급성골수구성백혈병에서 백혈구과정가증의 임상적 의의" 대한진단검사의학회 23 (23): 1-5, 2003

2 Tan D, "Therapeutic leukapheresis in hyperleukocytic leukaemias-the experience of a tertiary institution in Singapore" 34 : 229-234, 2005

3 Hölig K, "Leukocyte depletion by therapeutic leukocytapheresis in patients with leukemia" 39 : 241-245, 2012

4 Greenwood MJ, "Leukocyte count as a predictor of death during remission induction in acute myeloid leukemia" 47 : 1245-1252, 2006

5 Thiébaut A, "Impact of pre-induction therapy leukapheresis on treatment outcome in adult acute myelogenous leukemia presenting with hyperleukocytosis" 79 : 501-506, 2000

6 Bug G, "Impact of leukapheresis on early death rate in adult acute myeloid leukemia presenting with hyperleukocytosis" 47 : 1843-1850, 2007

7 Ganzel C, "Hyperleukocytosis, leukostasis and leukapheresis: practice management" 26 : 117-122, 2012

8 Dutcher JP, "Hyperleukocytosis in adult acute nonlymphocytic leukemia: impact on remission rate and duration, and survival" 5 : 1364-1372, 1987

9 Bruserud Ø, "Hyperleukocytosis and leukocytapheresis in acute leukaemias:experience from a single centre and review of the literature of leukocytapheresis in acute myeloid leukaemia" 23 : 397-406, 2013

10 Porcu P, "Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation and management" 39 : 1-18, 2000

11 Schwartz J, "Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue" 28 : 145-284, 2013

12 Stucki A, "Endothelial cell activation by myeloblasts: molecular mechanisms of leukostasis and leukemic cell dissemination" 97 : 2121-2129, 2001

13 Döhner H, "Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet" 115 : 453-474, 2010