Addressing Oncologic Emergencies

Leukostasis

Leukostasis (also called symptomatic hyperleukocytosis) is a medical emergency in patients with acute myeloid leukemia (AML) in blast crisis. It is recognized by an elevated blast cell count and symptoms of decreased tissue perfusion.1

Hyperleukocytosis (HL)

HL is commonly defined by white blood cell counts >100,000/mL, although white blood cell counts <100,000/mL have also been found to cause HL-related complications.1

HL is seen in up to 20% of patients with newly diagnosed AML. It is more common in patients with myelomonocytic (FAB-M4) leukemia, monocytic (FAB-M5) leukemia, or the microgranular variant of acute promyelocytic leukemia (APL) (FAB-M3). Symptoms of leukostasis are less frequent and usually affect patients with white blood cell counts over 100x109/L (100,000/mL).1

Disseminated intravascular coagulation (DIC)

DIC is a condition in which coagulation and fibrinolysis become abnormally (and often massively) activated within the vasculature, leading to ongoing coagulation and fibrinolysis.2

Sepsis

Severe sepsis is associated with 8.5% of all cancer deaths. However, the risk of severe sepsis is 15 times higher in patients with hematologic cancers, like AML, compared to the general population.3

References: 1. Röllig C, Ehninger G. How I treat hyperleukocytosis in acute myeloid leukemia. Blood. 2015;125(21):3246-3252. 2. Ookura M, Hosono N, Tasaki T, et al. Successful treatment of disseminated intravascular coagulation by recombinant human soluble thrombomodulin in patients with acute myeloid leukemia. Medicine (Baltimore). 2018;97(44):e12981. 3. Malik I, Cardenas-Turanzas M, Gaeta S, et al. Sepsis and acute myeloid leukemia: a population-level study of comparative outcomes of patients discharged from Texas hospitals. Clin Lymphoma Myeloma Leuk. 2017;17(12):e27-e32.