在急性早幼粒细胞白血病（APL）中，由于疾病本身或早期使用全反式维甲酸治疗，外周血中的细胞负荷增加可能导致诱导化疗前发生高白细胞症（HL）。然而，由于担心这种侵入性程序后的凝血病理性，治疗性白细胞分离法很少使用。该研究旨在评估APL中的白细胞分离的效果和安全性，特别是对疗效和安全性的评估。我们回顾性分析了2009年1月至2022年3月新诊断的APL患者。在323名患者中，85名患者在诱导化疗前的白细胞计数超过40×109/L。将这39名患者与另外46名未接受白细胞分离治疗的患者进行了临床和实验室参数比较。白细胞分离组与非分离组比较，30天生存率有向更有利的趋势（76.9％和67.4％；P = 0.24）。两组之间的并发症包括随后的重症监护单位护理（P = 0.23）和严重出血事件（P = 0.13）的发生率没有显著差异。患者被分为亚组，在“顺序性HL”组中，白细胞分离组和未分离组的生存率分别为92.3％（95％置信区间[CI]，77.8％-100.0％）对58.3％（95％CI，38.6％-78.1％）（P = 0.03），在“症状性HL”组中为76.7％（95％CI，61.5％-91.8％）与54.8％（95％CI，37.3％-72.4％）（P = 0.03）。此外，白细胞分离组中“顺序HL”亚组的分化综合征和随之而来的不良事件的累积发生率显著低于非分离组。在由疾病本身或全反式维甲酸作用引起的“顺序HL”或“症状性HL”的APL中，治疗性白细胞分离法可用于降低白血病细胞负荷而不会造成明显风险。版权所有©2023年国际细胞与基因治疗学会。由Elsevier Inc.出版。保留所有权利。

In acute promyelocytic leukemia (APL), increased cell burden in the peripheral blood due to either the disease itself or early treatment with all-trans retinoic acid could cause hyperleukocytosis (HL) before induction chemotherapy. However, therapeutic leukapheresis has seldom been used because of concerns of subsequent coagulopathy after this invasive procedure. The aim of this study was to evaluate the effects of leukapheresis in APL, especially for efficacy and safety.We retrospectively analyzed newly diagnosed patients with APL from January 2009 to March 2022. Among 323 patients, 85 had white blood cell count above 40 × 109/L before induction chemotherapy. Thirty-nine patients were initially treated with leukapheresis, whereas the other 46 were not. Clinical and laboratory parameters between these groups were compared.There was a trend toward favorable 30-day survival rate for the leukapheresis group compared with the non-leukapheresis group (76.9% and 67.4%; P = 0.24). The complications including subsequent intensive unit care (P = 0.23), severe hemorrhagic events (P = 0.13) showed no significant differences between the two groups. The patients were divided into subcohorts, and the survival rates of the leukapheresis and non-leukapheresis groups were 92.3% (95% confidence interval [CI], 77.8%-100.0%) versus 58.3% (95% CI, 38.6%-78.1%) (P = 0.03) in "sequential HL" and 76.7% (95% CI, 61.5%-91.8%) versus 54.8% (95% CI, 37.3%-72.4%) (P = 0.03) in "symptomatic HL," respectively. Moreover, in the "sequential HL" subcohort, the cumulative incidence of differentiation syndrome and following adverse events were significantly lower in the leukapheresis group.In APL with "sequential HL" or "symptomatic HL" from either the disease itself or the effect of all-trans retinoic acid, therapeutic leukapheresis could be applied to reduce leukemic cell burden without significant risks.Copyright © 2023 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.