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Pediatric Acute Myeloid Leukemia and Hyperleukocytosis with WBC count greater than 50×109/L
  • +12
  • Aoli Zhang,
  • Li-Peng Liu,
  • xiaoyan Chen,
  • Chao Liu,
  • Chengyi Wang,
  • Li-Xian Chang,
  • Xiaojuan Chen,
  • Wen-Yu Yang,
  • Ye Guo,
  • Li Zhang,
  • Yao Zou,
  • Yu-Mei Chen,
  • Yingchi Zhang,
  • Min Ruan,
  • Xiaofan Zhu
Aoli Zhang
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Li-Peng Liu
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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xiaoyan Chen
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Chao Liu
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Chengyi Wang
Fujian Provincial Maternity and Children’s Hospital
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Li-Xian Chang
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Xiaojuan Chen
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Wen-Yu Yang
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Ye Guo
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Li Zhang
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Yao Zou
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Yu-Mei Chen
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Yingchi Zhang
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Min Ruan
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Xiaofan Zhu
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
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Abstract

Background: Acute myeloid leukemia (AML) and hyperleukocytosis are related to an unfavorable prognosis. The impact of hyperleukocytosis on the prognosis of pediatric AML has not been fully explained so far. We aimed to assess the clinical characteristics and prognosis of pediatric AML with hyperleukocytosis, referred to as white blood cell (WBC) count ≥50×109/L. Methods: A total of 307 newly diagnosed non-acute promyelocytic leukemia patients were continuously enrolled at our center from October 2005 to September 2015. 81 patients with initial leukocyte counts ≥50×109/L. The baseline demographic and clinical characteristics of AML patients were compared. Progression-free survival (PFS) and overall survival (OS) were documented. Results: Hyperleukocytosis occurred in 26.38% of AML patients, and FAB M5 subtype (n=41, 50.62%) and FLT3-ITD mutations (n=16, 19.75%) had a high proportion in AML and hyperleukocytosis. Overall mortality was significantly higher in patients with hyperleukocytosis than patients without hyperleukocytosis (50.62% vs. 35.84%, P=.020). Patients with hyperleukocytosis had a lower 10-year PFS and OS rates than those without hyperleukocytosis (44.4%±9.4% vs. 59.7%±5.5%, P=.041; 49.4%±9.4% vs. 64.2%±5.4%, P=.051, respectively). There were similar PFS and OS rates between the subgroups of patients with WBC count 50-100×109/L and WBC count ≥100×109/L (43.8%±13.3% vs. 44.9%±12.3%, P=.507; 46.9%±13.3% vs. 51.0%±12.3%, P=.907, respectively). In all patients with hyperleukocytosis, male and FAB M5 subtype patients had a significantly inferior survival, while CBF-AML had a better survival. Conclusions: A WBC count greater than 50×109/L at onset was a critical predictive adverse factor in pediatric AML.