急性髓性白血病（AML）患者中的高白血病细胞计数与预后差有关。为达到细胞减少的效果，白细胞分离术已被使用，但其临床效用尚不明确，低剂量阿糖胞苷（LD-阿糖胞苷）被用作替代方法。研究了1997年至2017年间在机构方案下接受治疗的新诊断AML患儿。诊断时血液中白细胞计数≥100×109/L被定义为高白血病细胞计数。回顾了临床特征、早期并发症、生存数据和细胞减少方法的影响。在324名新诊断AML儿童中，49名（15.1％）患有高白血病细胞计数。高白血病细胞计数的初步管理包括白细胞分离或交换输血（n=16，被视为一组），LD-阿糖胞苷（n=18），氢基脲（n=1）和无白细胞减少（n=14）。与接受白细胞分离术的患者相比，接受LD-阿糖胞苷的患者白细胞计数干预后的白细胞计数下降百分比更大（48％ vs. 75％；p = .02），且从诊断到方案治疗开始的中位时间更长（28.1 vs. 95.2小时；p<.001）。感染发生率在接受白细胞分离术的患者中（38％）高于接受LD-阿糖胞苷（0％）或方案治疗白细胞减少的患者（14％）（p= .008）。在干预组中结果没有差异。虽然高白血病细胞计数患者的肺和代谢并发症发生率高于无患者，但早期死亡没有发生，两组的完全缓解、事件无进展生存、总体生存率和结局相似。LD-阿糖胞苷治疗似乎是AML和高白血病细胞计数患儿细胞减少的安全有效方法。 ©2023美国癌症协会。

Hyperleukocytosis in patients with acute myeloid leukemia (AML) has been associated with worse outcomes. For cytoreduction, leukapheresis has been used but its clinical utility is unknown, and low-dose cytarabine (LD-cytarabine) is used as an alternative method.Children with newly diagnosed AML treated between 1997 and 2017 in institutional protocols were studied. Hyperleukocytosis was defined as a leukocyte count of ≥100 × 109 /L at diagnosis. Clinical characteristics, early complications, survival data, and effects of cytoreductive methods were reviewed. Among 324 children with newly diagnosed AML, 49 (15.1%) presented with hyperleukocytosis. Initial management of hyperleukocytosis included leukapheresis or exchange transfusion (n = 16, considered as one group), LD-cytarabine (n = 18), hydroxyurea (n = 1), and no leukoreduction (n = 14).Compared with patients who received leukapheresis, the percentage decrease in leukocyte counts following intervention was greater among those who received LD-cytarabine (48% vs. 75%; p = .02), with longer median time from diagnosis to initiation of protocol therapy (28.1 vs. 95.2 hours; p < .001). The incidence of infection was higher in patients (38%) who had leukapheresis than those who receive LD-cytarabine (0%) or leukoreduction with protocol therapy (14%) (p = .008). No differences were noted in the outcomes among the intervention groups. Although patients with hyperleukocytosis had higher incidences of pulmonary and metabolic complications than did those without, no early deaths occurred, and the complete remission, event-free survival, overall survival rates, and outcomes of both groups were similar.LD-cytarabine treatment appears to be a safe and effective means of cytoreduction for children with AML and hyperleukocytosis.© 2023 American Cancer Society.