125 Leukapharesis for the treatment of hyperleukocytosis in Mantle Cell Lymphoma: Evidence and Experience

Introduction/Objective Mantle cell lymphoma (MCL) is a distinct B-cell neoplasm characterized by cyclin D1 overexpression due to the t(11;14) translocation. While MCL typically follows an aggressive course, hyperleukocytosis and leukostasis are rare manifestations, primarily associated with acute leukemias. Leukostasis occurs due to microvascular obstruction by circulating malignant cells, leading to respiratory and neurological complications. Although leukapheresis is widely used in acute myeloid leukemia with hyperleukocytosis, its role in MCL remains unclear. This study reviews reported cases of leukostasis in MCL, treatment strategies and outcomes and report an additional case managed with leukapharesis. Methods/Case Report A comprehensive literature review was conducted using PubMed employing search terms including “mantle cell lymphoma,” “hyperleukocytosis,” “leukocytapheresis,” and “leukostasis.” Six cases were identified where leukapheresis was used as a therapeutic intervention. Data on presentation, leukocyte count, treatment response, and survival outcomes were summarized. Results Among seven reported cases, six patients underwent leukapheresis. Most had aggressive MCL variants, including blastoid and prolymphocytoid subtypes. Leukapheresis led to transient leukoreduction and symptomatic improvement, but overall survival remained limited. Conclusion Leukapheresis may provide short-term symptomatic relief in MCL patients with leukostasis but does not replace systemic therapy. Early chemotherapy initiation remains crucial. Further studies are needed for leukapheresis guidelines in MCL-associated hyperleukocytosis.