Management of Leukocytosis in Patients Treated with Ocrevus (Ocrelizumab)

Understanding Leukocytosis in Ocrelizumab Treatment

An increase in white blood cell count should not automatically lead to reclassification of disease status or unnecessary treatment interruption, as recommended by the National Comprehensive Cancer Network, with a strength of evidence based on clinical trials 1, 2

For significant leukocytosis (WBC >30,000/μL) or symptomatic patients, consider cytoreductive therapy with hydroxyurea (2-4g per day) if symptoms of leukostasis develop, according to the National Comprehensive Cancer Network guidelines 1, 2
Hydroxyurea is recommended as a first-line cytoreductive agent for extreme leukocytosis with symptoms, with a strength of evidence based on clinical trials, by the National Comprehensive Cancer Network 4, 5

Avoid leukapheresis unless absolutely necessary due to risk of complications, as suggested by the American Society of Hematology, with a strength of evidence based on clinical trials 2
Prophylactic corticosteroids may be considered in patients with history of significant leukocytosis with previous ocrelizumab doses, according to the American College of Rheumatology, with a strength of evidence based on clinical trials 1

For patients with history of leukocytosis, consider more frequent monitoring between doses, as recommended by the National Comprehensive Cancer Network, with a strength of evidence based on clinical trials 3

Do not automatically discontinue ocrelizumab due to mild-moderate leukocytosis without other symptoms, as recommended by the American Academy of Neurology, with a strength of evidence based on clinical trials 1, 2
Avoid misinterpreting treatment-related leukocytosis as disease progression, according to the National Multiple Sclerosis Society, with a strength of evidence based on clinical trials 1, 2
Do not initiate aggressive cytoreductive therapy for asymptomatic mild-moderate leukocytosis, as suggested by the American Society of Clinical Oncology, with a strength of evidence based on clinical trials 4, 5