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Therapeutic Apheresis

(P-TA-19) Therapeutic Leukapheresis in a Case of Chronic Myeloid Leukemia Presenting with Trivial Trauma

Sunday, October 26, 2025
12:00 PM - 1:00 PM  PT
Background/Case Studies: Chronic Myeloid Leukemia (CML) is a clonal myeloproliferative disorder characterized by the presence of the BCR-ABL1 fusion gene. Hyperleukocytosis (WBC > 100 × 10⁹/L) may lead to leukostasis, especially when levels exceed 300 × 10⁹/L, resulting in end-organ dysfunction. Rapid leukoreduction is essential in such cases. Leukapheresis offers immediate cytoreduction and symptom relief. We report a case of a 43-year-old male who presented with a trivial trauma to the back and soft tissue swelling—hematoma in the left lateral chest wall. An ultrasound confirmed the presence of a hematoma; an evacuation was done, and 1 liter of clot was evacuated. 2 units of PRBC were transfused due to low hemoglobin. Laboratory evaluation revealed a markedly elevated WBC count of 320 × 10⁹/L with a peripheral smear suggestive of chronic phase CML. The patient developed symptoms consistent with leukostasis, including respiratory distress and altered mental status. Immediate leukoreduction was initiated via therapeutic leukapheresis.

Study

Design/Methods:

  • Patient: 43-year-old male

  • Symptoms: soft tissue swelling—hematoma in left lateral chest wall.

  • WBC count: 320 × 10⁹/L revealed during laboratory evaluation before hematoma evacuation.

  • Diagnosis: CML, chronic phase confirmed by bone marrow morphology and BCR-ABL1 positivity (RT-PCR).

  • Intervention:


    • Two leukapheresis sessions were performed using the Hemonetics MCS Machine (intermittent flow cell separator).

    • Concurrent cytoreduction with hydroxyurea, followed by imatinib.




Results/Findings:

  • WBC Reduction:


    • After 1st session: ↓ by 35%

    • After 2nd session: ↓ to 160 × 10⁹/L


  • Clinical Improvement: Noted within 48 hours.

  • No major adverse effects were seen.

  • Follow-up: Patient remained stable on TKI therapy with hematological remission at 3 months.




Conclusions: Leukapheresis is a rapid, safe, and effective CML intervention for managing hyperleukocytosis. While not curative, it facilitates stabilization and transition to disease-modifying therapy, reducing the risk of leukostasis-related complications.