Therapeutic leukocytapheresis for improvement in respiratory function in a woman with hyperleukocytosis and mantle cell lymphoma with a circulating small lymphocyte phenotype
Authors
Kwan, LauraLinden, Jeanne
Gaffney, Kathleen
Greene, Mindy
Vauthrin, Michelle
Ramanathan, Muthalagu
Weinstein, Robert
UMass Chan Affiliations
Department of Medicine, Division of Hematology/OncologyDepartment of Pathology
Department of Medicine, Division of Transfusion Medicine
Document Type
Journal ArticlePublication Date
2015-08-31Keywords
apheresisdyspnea
hematological malignancy
leukocytapheresis
leukostasis
Hematology
Hemic and Immune Systems
Hemic and Lymphatic Diseases
Metadata
Show full item recordAbstract
Mantle cell lymphoma is an aggressive malignant B-cell disorder that often presents with a leukemic picture. Circulating lymphoma cell morphology may vary from small round mature-appearing lymphocytes resembling the lymphocytes of chronic lymphocytic leukemia to large prolymphocytoid or blastoid cells. Rare reports of hyperleukocytosis with leukostasis, treated with leukocytapheresis, are described in patients with prolymphocytoid or blastoid morphology. We report an 88 year old woman with mantle cell lymphoma, hyperleukocytosis (WBC > 400 x 103 /microL) with severe respiratory compromise but without interstitial or alveolar infiltrates on radiograph or computerized tomography of the chest. She was afebrile and had no central nervous system signs. Circulating lymphoma cell morphology was predominantly of the small lymphocyte type. A two-whole-blood-volume leukocytapheresis reduced her WBC from 465 to 221 x 103 /microL in 150 min. Her respiratory rate decreased from 28/min to 18/min and her arterial oxygen saturation (SpO2 ) rose from 91% to 97% on 6 L/min of oxygen by nasal cannula. Severe breathlessness before the procedure abated completely by the end of the procedure. Respiratory compromise may occur in mantle cell lymphoma with hyperleukocytosis with a mature lymphoma cell phenotype, even without a clear picture of leukostasis. Although the ultimate survival of the patient depends on treatment with chemotherapy, leukocytapheresis for alleviation of symptoms may be warranted and should be considered. Respiratory status and response to leukocytapheresis should be documented with physiological measurements.Source
J Clin Apher. 2015 Aug 31. doi: 10.1002/jca.21411. Link to article on publisher's site. [Epub ahead of print]DOI
10.1002/jca.21411Permanent Link to this Item
http://hdl.handle.net/20.500.14038/50109PubMed ID
26332581Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1002/jca.21411