A child with acute myeloid leukemia presents with hyperleukocytosis. Treatment includes all of the following except –

Hyperleukocytosis and Leukostasis Hyperleukocytosis refers to condition in which patients with acute leukemia present with an extraordinary high leukocyte count usually greater than 100,000/ 1. Leukostasis (Also known as symptomatic hyperleukocytosis) is a medical emergency most commonly seen in patients with AML or CML in blast crisis. There is sludging of leukemia blasts in the microcirculation (due to extremely elevated blast cells) leading to obstruction of small vessels especially in the cerebral and pulmonary circulation. Treatment of hyperleukocytosis includes : - 1. Immediate leukoreduction (cytoreduction) Immediate leukoreduction is required to lower the blast cells. This can be achieved by leukopharesis or by administration of hydroxyurea. 2. Induction chemotherapy Induction chemotherapy is initiated early, but only after attempts at leukoreduction (not immediately) as immediate administration of induction chemotherapy carries a high risk of acute tumor lysis syndrome. So, early induction chemotherapy is advised but not immediately. 3. Supportive/Prevention of complications Supportive therapy is given to prevent/reduce the metabolic complications of tumor lysis syndrome. It includes IV hydration, allopurinol and alkalinization of urine.