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. Author manuscript; available in PMC: 2021 Feb 22.
Published in final edited form as: Br J Haematol. 2008 Jun 9;142(3):497–501. doi: 10.1111/j.1365-2141.2008.07219.x

Table I.

Patient demographic and clinical information.

Patients with symptoms consistent with leucostasis* Asymptomatic patients
Patient no. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Age, years 15 5 months 8 13 5 7 8 3 7 16 18 3 14 6 months 2
Imaging NA Brain MR - CSF prominence Brain MR - thalamic infarct Brain MR - normal Normal Normal Normal Normal Normal Normal Normal Normal CXR - large anterior mass Normal Normal
Symptoms and physical examination findings Haemoptysis, respiratory failure** Bilateral papilledema, chloroma of right orbit Dyspnea, cough, tachnypnea Blurry vision in left eye with decreased visual acuity, bilateral papilledema Normal Normal Splenomegaly Normal Normal Normal Normal Normal Normal Normal Normal
Sex, M/F Male Female Male Female Male Male Male Female Male Female Female Female Male Female Female
ALL subtype Pre-B (refractory, relapsed) Pre-B (CALLA negative) T-cell precursor Pre-B (CALLA negative) Pre-B Pre-B T-cell precursor Pre-B T-cell precursor Pre-B Pre-B Pre-B T-cell precursor Pre-B Pre-B
Cytogenetics t(9;22) (q34;qll) t(4;11) (q21;q23) Normal t(4;11) (q21;q23) Normal Normal t(11;14) (pl3;ql) Normal -Y, −9p Normal Normal Hyperploidy XYY, t(2;13) t(4;ll) (q21;q23) Hyperploidy
WBC × 109/l 33·3 420·5 453·0 169·0 142·4 256·3 476·3 189·4 221·0 2·1 55·0 51·8 225.0 14.4 94.1
Blasts × 109/l 32·0 395·3 317·1 150·4 110·7 230·2 433·2 158·6 179·01 0·4 52·8 36·77 209·25 11·52 81·87
Hb (g/l) 93 67 113 40 56 52 97 82 98 85 86 81 53 107 97
Platelets × 109/l 26 21 9 7 125 11 45 65 44 78·0 39 37 37 50 37
Uric acid (μmol/l) 53·5 374·7 398·5 339·0 463·9 190·3 398·5 410·4 547·2 422·3 446·1 130·9 606·7 172·5 565·1
Lactate Dehydrogenase (IU/l) NA 1619 >2700 1266 825 1225 2544 543 7000 434 1069 407 707 317 1250

NA, not available; MR, magnetic resonance; CSF, cerebrospinal fluid; ALL, acute lymphoblastic leukaemia; WBC, white blood cells.

*

Although leucostasis may occur in other organ systems as well, only haematological, neurological, and/or respiratory dysfunction were observed in our patient sample. In addition, no evidence of serious bacterial infection/sepsis (all patients were afebrile at the time of the blood draw) or renal dysfunction due to uric acid nephropathy and tumor lysis syndrome was seen in any of the patients studied.

**

Of note, patient 1 was diagnosed with aspergillous pneumonia (diagnosed via broncho-alveolar lavage) 6 months prior to his death. He was successfully treated with caspofungin and voriconazole, which he received continuously until his death. During the last 2 weeks of his life, he did not experience any respiratory symptoms or fever until the day of his death. Serial chest radiographs revealed no abnormality during that time. The only detectable change in his clinical status, aside from increase in leukaemia cell stiffness, was an increasing number of circulating leukaemia cells during his last week (leukaemia cell concentration during his last 3 d of life: 10·92, 15·57, 32·0 × 109 cells/l respectively). On the day he died, he remained afebrile but developed progressively worsening respiratory failure over several hours and haemoptysis in the last hour of life. The correlation between cell concentration and cell stiffness was not statistically significant (P = 0.23), and the leukaemia cell concentration did not reach levels consistent with hyperleucocytosis.