Physiological measurements corroborate symptomatic improvement after therapeutic leukapheresis in a pregnant woman with chronic myelogenous leukemia
Department of Medicine, Division of Transfusion Medicine; Department of Pathology; Department of Medicine, Division of Hematology/Oncology
Hematology | Hemic and Immune Systems | Hemic and Lymphatic Diseases | Maternal and Child Health | Obstetrics and Gynecology | Women's Health
Therapeutic leukapheresis can control the white blood cell count (WBC) of pregnant women with chronic myelogenous leukemia (CML) who have hyperleukocytosis without leukostasis. The medical justification for this treatment has not been objectively documented. We report a 27-year-old woman, diagnosed with CML at 10-week gestation, who developed severe dyspnea on exertion. A workup that included chest CT and echocardiography with a bubble study detected no cardiopulmonary pathology to explain her symptoms, and thus she was referred for leukapheresis. Prior to her first leukapheresis, which lowered her WBC from 154 x 103 /muL to 133 x 103 /muL, her oxygen saturation (SpO2 ) on room air decreased from 98 to 93% during 100 feet of slow ambulation and she was dyspneic. Just after the leukapheresis, her dyspnea on exertion was much improved and her SpO2 remained at 98% with repeat ambulation. Spirometry and lung volume studies obtained before and after her first leukapheresis demonstrated 32 and 31% improvements in forced vital capacity and forced expiratory volume in 1 s respectively, a 25% increase in functional residual capacity, and a 142% improvement in expiratory reserve volume. Residual volume decreased by almost 20%. Three times in a week, leukapheresis was continued until her WBC was controlled with interferon alpha-2b approximately 4 weeks later. Her dyspnea had completely resolved. She gave birth by elective caesarean section to a healthy boy at 32 weeks. Corroboration of symptom relief by leukapheresis with physiological data may justify such treatment in pregnant patients with CML.
dyspnea, hyperleukocytosis, myeloproliferative neoplasm, pulmonary function tests
DOI of Published Version
J Clin Apher. 2015 Jun 6. doi: 10.1002/jca.21410. Link to article on publisher's site. [Epub ahead of print]
Journal of clinical apheresis
Galera, Pallavi; Haynes, Stefanie; Sulmasy, Paula; Bailey, Jeffrey A.; Greene, Mindy; Vauthrin, Michelle; Bretttler, Doreen B.; Liebmann, James; Madison, John Mark; and Weinstein, Robert, "Physiological measurements corroborate symptomatic improvement after therapeutic leukapheresis in a pregnant woman with chronic myelogenous leukemia" (2015). Transfusion Medicine Publications and Presentations. 9.