白细胞单采术在不同血液系统恶性疾病高白细胞中的应用及疗效

Application and Efficacy of Leukapheresis in Different Hematological Malignancies with Hyperleukocytosis

目的探讨白细胞单采术在不同血液系统恶性疾病高白细胞中的应用及疗效。方法运用COBE Spectra血细胞分离机对183例高白细胞血液系统恶性疾病患者进行296次紧急白细胞单采术并分析其疗效。结果183例患者中,男性100例,女性83例;急性髓系白血病(AML)占50%,慢性粒细胞白血病(CML)占17%,ph阴性和阳性急性B淋巴细胞白血病(B-ALL)分别占14%和9%,急性T淋巴细胞白血病(T-ALL)占7%,滤泡型淋巴瘤白血病(FL)占3%。单采时,白细胞数(50~100)×10^(9)/L组患者有72例,白细胞数(101~200)×10^(9)/L组有134例,白细胞数>200×10^(9)/L组有90例。经治1次白细胞单采术后,外周血平均白细胞数由(178.5±6.5)(53.1~796.1)×10^(9)/L降至(114.1±5.6)(22.6~586.9)×10^(9)/L。在不同疾病类型中,与CML患者相比,AML和ph阴性B-ALL患者在第一次白细胞单采后白细胞下降更明显(60.7×10^(9)/L vs.97.5×10^(9)/L,P=0.0314;70.5×10^(9)/L vs.97.5×10^(9)/L,P=0.0277)。在白细胞数(50~100)×10^(9)/L组患者中,一次单采后各种疾病白细胞数下降差异无统计学意义;白细胞数(101~200)×10^(9)/L组患者中,ph阴性B-ALL和AML与CML患者相比,白细胞分别下降89.9×10^(9)/L vs.32.0×10^(9)/L(P=0.0001)和63.5×10^(9)/L vs.32.0×10^(9)/L(P=0.0102);白细胞数>200×10^(9)/L组患者中,ph阴性B-ALL和CML患者相比,白细胞数下降差异有统计学意义(141.6×10^(9)/L vs.96.3×10^(9)/L,P=0.0033)。在不同白细胞数3组中,白细胞单采后白细胞分别下降37.7(-4.8~60.1)×10^(9)/L,60.9(5.5~132.8)×10^(9)/L和91.6(6.4~469.0)×10^(9)/L(P<0.0001);AML患者白细胞单采后白细胞分别下降39.2(13.8~60.1)×10^(9)/L,61.2(10.7~113.0)×10^(9)/L和85.5(26.2~149.0)×10^(9)/L(P<0.0001);B-ALL患者白细胞单采后白细胞分别下降37.5(-4.8~56.0)×10^(9)/L,77.2(22.0~132.8)×10^(9)/L和130.4(86.3~215.2)×10^(9)/L(P<0.0001);T-ALL患者白细胞单采后白细胞分别下降34.3(15.5~55.3)×10^(9)/L,59.6(38.9~81.5)×10^(9)/L和120.9(47.4~190.5)×10^(9)/L(P=0.0022);在CML患者白细胞单采后白细胞分别下降32.2(23.6~54.6)×10^(9)/L,33.5(5.5~73.2)×10^(9)/L和75.0(6.4~469.0)×10^(9)/L(P=0.0005);FL患者白细胞单采后白细胞分别下降24.2×10^(9)/L,43.7(27.1~62.5)×10^(9)/L和89.2(53.7~157.9)×10^(9)/L(P=0.0116)。结论白细胞单采术是治疗高白细胞白血病的有效方法。白细胞越高,白细胞单采效果更好;不同疾病白细胞单采存在差异,AML和ph阴性B-ALL患者白细胞单采效果更好,CML患者白细胞单采效果欠佳。

Objective To explore the application and efficacy of leukapheresis in different hematological malignancies with hyperleukocytosis.Methods The COBE Spectra blood cell separator was used to perform 296 emergency leukapheresis on 183 patients with hyperleukocytic hematological malignancies.Clinical efficacy was compared and analyzed.Results Of the 183 patients(100 males and 83 females),50%were acute myeloid leukemia(AML),17%were chronic granulocytic leukemia(CML),14%were ph-negative B-cell acute lymphocytic leukemia(B-ALL),9%were ph-positive B-ALL,7%were T-cell acute lymphocytic leukemia(T-ALL),and 3%were follicular lymphoma leukemia(FL).Before leukapheresis,there were 72 patients in the WBC count(50-100)×10^(9)/L group,134 patients in the WBC count(101-200)×10^(9)/L group,and 90 patients in the WBC count>200×10^(9)/L group.After first leukapheresis treatment,the average WBC count decreased from(178.5±6.5)(53.1-796.1)×10^(9)/L to(114.1±5.6)(22.6-586.9)×10^(9)/L.Compared with CML,AML and phnegative B-ALL patients had significant WBC decline(60.7×10^(9)/L vs.97.5×10^(9)/L,P=0.0314;70.5×10^(9)/L vs.97.5×10^(9)/L,P=0.0277).In patients with a WBC count of(50-100)×10^(9)/L,there was no difference in the decrease of WBC count of various diseases.In patients with a WBC count of(101-200)×10^(9)/L,WBC decreased significantly more in patients with ph-negative B-ALL(89.9×10^(9)/L vs.32.0×10^(9)/L,P=0.0001)and AML(63.5×10^(9)/L vs.32.0×10^(9)/L,P=0.0102)than in patients with CML.In patients with a WBC count>200×10^(9)/L,there was a significant difference in the decrease of WBC count compared to patients with ph-negative B-ALL and CML(141.6×10^(9)/L vs.96.3×10^(9)/L,P=0.0033).In the 3 groups with different WBC counts,WBC decreased by 37.7(-4.8-60.1)×10^(9)/L,60.9(5.5-132.8)×10^(9)/L and 91.6(6.4-469.0)×10^(9)/L after first leukapheresis in all patients(P<0.0001).WBC decreased by 39.2(13.8-60.1)×10^(9)/L,61.2(10.7-113.0)×10^(9)/L and 85.5(26.2-149.0)×10^(9)/L in AML patients(P<0.0001).WBC decreased by 37.5(-4.8-56.0)×10^(9)/L,77.2(22.0-132.8)×10^(9)/L and 130.4(86.3-215.2)×10^(9)/L in B-ALL patients(P<0.0001).WBC decreased by 34.3(15.5-55.3)×10^(9)/L,59.6(38.9-81.5)×10^(9)/L and 120.9(47.4-190.5)×10^(9)/L in T-ALL patients(P=0.0022).WBC decreased by 32.2(23.6-54.6)×10^(9)/L,33.5(5.5-73.2)×10^(9)/L and 75.0(6.4-469.0)×10^(9)/L in CML patients(P=0.0005).WBC decreased by 24.2×10^(9)/L,43.7(27.1-62.5)×10^(9)/L and 89.2(53.7-157.9)×10^(9)/L in FL patients(P=0.0116).Conclusion Leukapheresis was an effective treatment for hematological malignancies with hyperleukocytosis.The efficacy of leukapheresis was better for patients with a higher WBC count.Treatment effects varied from disease to disease,with better results in patients with AML and ph-negative B-ALL,but poor results in patients with CML.