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International Journal of Laboratory... Apr 2020Leukemoid reaction (leukocyte count >50 cells ×10 L) is a rare but extremely relevant finding. Since little has been published on this condition's clinical relevance... (Clinical Trial)
Clinical Trial
INTRODUCTION
Leukemoid reaction (leukocyte count >50 cells ×10 L) is a rare but extremely relevant finding. Since little has been published on this condition's clinical relevance and prognosis, we investigated leukemoid reaction in patients with a white blood cell count of >50 × 10 L, including etiology and outcomes.
METHODS
This retrospective cohort study included all patients at a Brazilian tertiary hospital between January 2016 and July 2018 > 18 years with a total leukocyte count >50 cells×10 L. Demographics, complete blood count, clinical features, and the exams used to diagnose and determine leukemoid reaction etiology were analyzed. A Kaplan-Meyer survival analysis was performed, and a binary logistic regression model identified variables associated with death.
RESULTS
Of the 267 cases with white blood cell count of >50 × 10 , 162/267 (60%) were secondary to hematopoietic neoplasm and 105/267 (40%) presenting as a true leukemoid reaction. The primary causes of the true leukemoid reaction cases were infection (59), nonhematopoietic neoplasm (17), or other causes (29). Patient deaths (66) differed significantly between groups (P < .001, log-rank [Mantel-Cox] Test). Lower hemoglobin, older age, and increased segmented neutrophil count were associated with increased risk of death.
CONCLUSIONS
This was a modern cohort analysis of leukemoid reactions, inclusive of all etiologies. The most common cause was infection, which involved several microorganisms. Paraneoplastic leukemoid reaction was also common. Both conditions have a poor prognosis with high mortality, being a major medical challenge.
Topics: Adult; Age Factors; Aged; Disease-Free Survival; Female; Hemoglobins; Humans; Leukemoid Reaction; Leukocyte Count; Male; Middle Aged; Retrospective Studies; Survival Rate
PubMed: 31765058
DOI: 10.1111/ijlh.13127 -
Ryoikibetsu Shokogun Shirizu 1998
Review
Topics: Bacterial Infections; Diagnosis, Differential; Hematologic Diseases; Humans; Leukemoid Reaction; Neoplasms; Poisoning; Prognosis; Virus Diseases
PubMed: 9833409
DOI: No ID Found -
Pathology, Research and Practice Jan 2021We recently encountered a patient with unexplained hyperleukocytosis (105.4 K/μL at presentation), subsequently found to have colon cancer with a marked... (Review)
Review
OBJECTIVES
We recently encountered a patient with unexplained hyperleukocytosis (105.4 K/μL at presentation), subsequently found to have colon cancer with a marked tumor-associated neutrophilic infiltrate; the leukocytosis abruptly improved after tumor removal. Paraneoplastic leukemoid reaction (PLR) is a rare entity, occurring due to tumor cytokine secretion (typically granulocyte-colony stimulating factor [G-CSF]). We describe a case and aggregate results of previously published cases.
METHODS
We reviewed the English-language literature for all prior reports of PLR, recording age, gender, histologic diagnosis, WBC count, G-CSF level, and overall survival. We analyzed clinicopathologic variables' impact on survival.
RESULTS
We identified 179 cases (mean age 64; 72 % M). Adeno-, squamous cell, sarcomatoid, and undifferentiated carcinomas accounted for >70 %. Esophagus, gallbladder, lung, liver, and pancreas were the most common primaries. At time of publication 81 % of patients had died, with mean overall survival of 4 months. There was no correlation between WBC count and G-CSF level. On univariate analysis, WBC count was the only variable associated with survival (P = 0.03). Patients with WBC counts >100 K/μL were twice as likely to die as those with counts from 11 K to 40 K/μL.
CONCLUSIONS
PLR, typically carcinoma-associated, is characterized by dismal prognosis. The WBC count is inversely related to survival. Knowledge of this phenomenon militates against protracted, expensive work ups. In malignant neoplasms with prominent neutrophilic stroma, the pathologist should correlate with the WBC count and, if markedly elevated (>40 K/μL), raise consideration for PLR.
Topics: Adult; Aged; Aged, 80 and over; Colectomy; Colonic Neoplasms; Fatal Outcome; Female; Granulocyte Colony-Stimulating Factor; Humans; Leukemoid Reaction; Leukocyte Count; Male; Middle Aged; Neutrophil Infiltration; Paraneoplastic Syndromes; Treatment Outcome
PubMed: 33341546
DOI: 10.1016/j.prp.2020.153295 -
Revista Espanola de Medicina Nuclear E... 2022
Topics: Carcinoma, Ovarian Epithelial; Female; Fluorodeoxyglucose F18; Humans; Leukemoid Reaction; Ovarian Neoplasms; Positron Emission Tomography Computed Tomography
PubMed: 35193815
DOI: 10.1016/j.remnie.2022.01.001 -
The Journal of International Medical... Jan 2021Leukemoid reaction complicated by thrombocytopenia is rare, usually seen in patients with malignant conditions, and is often associated with poor prognosis. Here, the... (Review)
Review
Leukemoid reaction complicated by thrombocytopenia is rare, usually seen in patients with malignant conditions, and is often associated with poor prognosis. Here, the case of a 28-year-old healthy female without exceptional past medical history, who suffered from severe vaginal infection, is reported. Although symptoms improved, the white blood cell (WBC) count continued to increase up to 78 460 cells/µl, however, the patient continued to improve and the outcome was good. The case revealed that an increasing WBC count may not change in synchrony with clinical symptoms. When faced with this scenario, procalcitonin measurements may play an important role in differentiating diagnosis and guiding treatment.
Topics: Adult; Communicable Diseases; Female; Humans; Leukemoid Reaction; Leukocyte Count; Leukopenia; Thrombocytopenia
PubMed: 33423588
DOI: 10.1177/0300060520974257 -
BMC Cancer Sep 2014The presentation of a leukemoid reaction in cervical cancers is rare. A leukemoid reaction is defined as leukocytosis associated with a cause outside the bone marrow,... (Review)
Review
BACKGROUND
The presentation of a leukemoid reaction in cervical cancers is rare. A leukemoid reaction is defined as leukocytosis associated with a cause outside the bone marrow, with the white blood cell count (WBC) exceeding 50*109/L. Two cervical cancers presenting with leukemoid reactions were previously reported. However, the cancers in these cases were mainly in the advanced stages and had a poor outcome.
CASE PRESENTATION
Here we report a 40-year old patient with clinical stage (FIGO IIA1) cervical squamous carcinoma suffering from vaginal cuff recurrence with a leukemoid reaction two months after laparoscopic radical hysterectomy. The patient suffered from persistent fever and leukocytosis after one month of antibiotic treatment accompanied by rapid growth of the vaginal mass indicated that the leukocytosis could not be caused only by infection. After paclitaxel injection, the WBC count increased to 70.37*109/L. Bone marrow aspirates and biopsy showed left-shift neutrophilia, which confirmed leukemoid reaction. After two courses of paclitaxel and cisplatin treatment, the white blood cell counts decreased to normal, the fever disappeared, and the vaginal mass was reduced dramatically. She achieved completed remission after subsequent chemo-radiation and two additional courses of chemotherapy.
CONCLUSION
In our case, leukemoid reaction was related to recurrent cervical carcinoma and sensitive to chemotherapy. To our knowledge, this is the third case to be reported in the literature. Furthermore, this is the only case described that shows an unequivocal correlation between tumor response and leukemoid reaction.
Topics: Adult; Biomarkers, Tumor; Biopsy; Female; Humans; Immunohistochemistry; Leukemoid Reaction; Leukocyte Count; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Treatment Outcome; Tumor Burden; Uterine Cervical Neoplasms
PubMed: 25223869
DOI: 10.1186/1471-2407-14-670 -
International Journal of Pediatric... May 2014Nasopharyngeal carcinoma is a tumor originating from the surface epithelial cells of nasopharynx. It is rare in children and adolescents. Most common physical finding is... (Review)
Review
Nasopharyngeal carcinoma is a tumor originating from the surface epithelial cells of nasopharynx. It is rare in children and adolescents. Most common physical finding is a neck mass. Most children with nasopharyngeal carcinoma present with advanced stage disease. The presentation with hematological abnormalities in patients without systemic metastasis is extremely rare. We reported a 14-year-old boy presenting with a mass at the right side of the pharynx and leukemoid reaction. To our knowledge, this is the first report of leukemoid reaction associated with pediatric nasopharyngeal carcinoma in English literature.
Topics: Adolescent; Biopsy, Needle; Carcinoma; Chemoradiotherapy; Diagnosis, Differential; Follow-Up Studies; Humans; Immunohistochemistry; Leukemoid Reaction; Male; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Neoplasm Invasiveness; Neoplasm Staging; Rare Diseases; Treatment Outcome
PubMed: 24646685
DOI: 10.1016/j.ijporl.2014.02.016 -
European Journal of Pediatrics Jul 2018Leukemoid reaction (WBC > 30,000/μL) may indicate significant medical conditions, mostly infectious. Prompted by the lack of population-based data on the...
UNLABELLED
Leukemoid reaction (WBC > 30,000/μL) may indicate significant medical conditions, mostly infectious. Prompted by the lack of population-based data on the presentation, characteristics, and necessary workup in children with leukemoid reaction, we searched the database of a tertiary pediatric medical center for all children presented with at least one WBC count of ≥ 30,000/μL in 2009-2014. Demographic, clinical, and laboratory parameters were recorded. Children admitted with WBC < 30,000/μL served as controls. Pneumonia was the most common diagnosis in the leukemoid reaction group, with a 5.5-fold higher prevalence of pleuropneumonia than in the control group. The leukemoid group had a longer average hospital stay (7.5 vs. 5.5 days). Patients with WBC ≥ 50,000/μL had a sixfold higher rate of leukemia than patients with a lower count. There was a significant association of leukemia with low platelet count, low levels of C-reactive protein, and high levels of uric acid and lactate dehydrogenase.
CONCLUSION
Children presented with a leukemoid reaction are at high risk of pneumonia, especially pleuropneumonia, and a long hospital stay. Those with WBC ≥ 50,000/μL have a sixfold higher risk of leukemia. For prompt diagnosis, clinicians should be aware of the variables associated with leukemia. What is Known: • Leukemoid reaction has been associated with infectious diseases. • Leukemoid reaction at presentation in adults is correlated with high morbidity and mortality. What is New: • Children with leukemoid reaction are at high risk of pleuropneumonia. • We did not observe increased mortality in children with a leukemoid reaction.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Length of Stay; Leukemoid Reaction; Leukocyte Count; Male; Retrospective Studies; Young Adult
PubMed: 29696475
DOI: 10.1007/s00431-018-3155-5 -
Indian Journal of Pediatrics Jun 2023
Topics: Pregnancy; Female; Humans; Infant; Leukemia, Myelomonocytic, Juvenile; Leukemoid Reaction; Chorioamnionitis
PubMed: 36826748
DOI: 10.1007/s12098-023-04517-9 -
International Journal of Hematology Dec 2022The development of myeloid leukocytosis in leukemia patients during antileukemic treatment requires a differential diagnosis between myeloid leukemoid reaction and...
The development of myeloid leukocytosis in leukemia patients during antileukemic treatment requires a differential diagnosis between myeloid leukemoid reaction and leukemia progression. We herein report the case of an 80-year-old Japanese man with chronic myelomonocytic leukemia (CMML) who developed marked myeloid leukocytosis (36.3 × 10/L) with 32.5% monocytes and 48% neutrophils about 4 weeks after the initial 5-azacitidine (AZA) treatment. The leukocytosis was unlikely to be attributed to infection and adverse drug reaction. As it resolved in a few days without any interventions, the transient myeloid leukocytosis was confirmed to be a myeloid leukemoid reaction. After four cycles of AZA treatment, leukemic blasts in the bone marrow decreased and the patient became transfusion-independent. Interestingly, levels of serum G-CSF showed a similar trend to the myeloid leukocytosis, while those of serum GM-CSF and IL-17 were undetectable throughout the clinical course, suggesting that a differentiation response to AZA treatment might lead to the myeloid leukemoid reaction. Our case implies that a marked but transient myeloid leukemoid reaction mimicking CMML progression can develop during AZA treatment, which requires careful clinical monitoring and differential diagnosis.
Topics: Male; Humans; Aged, 80 and over; Leukemia, Myelomonocytic, Chronic; Azacitidine; Leukemoid Reaction; Leukocytosis; Leukemia, Myelomonocytic, Juvenile
PubMed: 35852697
DOI: 10.1007/s12185-022-03422-9