Clinical Challenges and Management of Hyperleukocytosis and Leukostasis in Hematologic Cancers

Hyperleukocytosis is dened as a white blood cell (WBC) count exceeding 100,000/microL in patients with leukemia, particularly acute myeloid leukemia (AML). Leukostasis, or symptomatic hyperleukocytosis, results in microvascular occlusions causing respiratory distress, central nervous system abnormalities, and organ dysfunction. The epidemiology varies, with hyperleukocytosis frequently observed in AML, affecting up to 20% of newly diagnosed patients, and less commonly in other leukemias. The pathophysiology involves increased blood viscosity and endothelial adhesion, leading to tissue hypoxia. Clinical manifestations include neurological and respiratory symptoms, necessitating early recognition and intervention. Treatment involves cytoreductive therapy, supportive care, and monitoring, aiming to reduce the high initial mortality associated with leukostasis.