Evaluation and Management of Severe Leukocytosis

Diagnostic Approach and Management

• The American Society of Clinical Oncology recommends considering bone marrow examination if hematologic malignancy is suspected, especially with abnormalities in other cell lines 1
• Patients with Acute Myeloid Leukemia (AML) and excessive leukocytosis at presentation may require emergency leukapheresis prior to induction chemotherapy, as suggested by the European Society for Medical Oncology 1
• The National Comprehensive Cancer Network recommends induction chemotherapy for AML, including an anthracycline and cytosine arabinoside 1
• Acute Promyelocytic Leukemia (APL) represents a medical emergency due to risk of fatal hemorrhage, and treatment with all-trans retinoic acid (ATRA) should be started immediately if APL is suspected, according to the American Society of Hematology 2
• Coagulopathy management is critical in APL, maintaining fibrinogen above 100-150 mg/dL and platelets above 30-50 × 10^9/L, as recommended by the International Society on Thrombosis and Haemostasis 3
• Symptomatic leukocytosis in Chronic Myelogenous Leukemia (CML) may be treated with hydroxyurea, apheresis, or tyrosine kinase inhibitors, as suggested by the National Comprehensive Cancer Network 4
• Risk stratification using Sokal or Hasford scoring systems guides treatment approach in CML, according to the European LeukemiaNet 4