Leukostasis-Related Pulmonary Distress Syndrome and Leukemic Infiltrates

23 Aug

BASICS:

Hyperleukocytosis is commonly found in newly diagnosed AML, with up to 10-20% of cases

-In contrast, leukemic infiltrates are seen in less than 7% of leukemia patients

DIAGNOSIS:

-Concern for leukostasis/leukemic infiltrates is generally reserved for only the highest WBC counts (100×109 L-1)

Leukemic Infiltrates

-Relatively non-specific radiographic findings including bilateral interstitial and airspace opacities

-Often have other complications such as pneumonia, hemorrhage, or pulmonary edema as well which make findings less specific

-The most common radiographic intrathoracic finding in any myeloid leukemia is simply mediastinal lymphadenopathy

Leukostasis on Imaging

May appear similar to a PE on CTPA!

CXR can be normal or show bilateral airspace consolidation

MANAGEMENT

Treatment for these conditions is generally based most on treatment of the malignancy- do not start anticoagulation on these patients!

Leukopharesis in combination with chemotherapy is the standard of care

-For patients with either of these conditions, also be concerned for Tumor Lysis Syndrome given the high cell turnover and high WBC count needed to generate this condition so close monitoring will be necessary.

 

Submitted by J. Grover.

 

References: Koh TT, Colby TV, Muller NL.  “Myeloid Leukemias and Lung Involvement”.  Seminars in Respiratory and Critical Care Medicine.  2005 Oct;26(5):514-9.  Piro, E, Carillio G et al.  “Reversal of Leukostasis-Related Pulmonary Distress Syndrome After Leukopharesis and Low-Dose Chemotherapy in Acute Myeloid Leukemia.”  Journal of Clinical Oncology.  Vol 29, No. 26 (September) 2011: 725-726.; picture

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