AM25-MN-30-L - Debate: Therapeutic Leukapheresis in Hyperleukocytosis—Data-Driven or Dubious?

Hyperleukocytosis may provoke morbidity and mortality due to leukostasis, disseminated intravascular coagulation, and tumor lysis syndrome. Utility of therapeutic leukocyte apheresis (TA) for hyperleukocytosis is debated due to uncertain efficacy and safety. Recent studies have not demonstrated concrete mortality benefit to the addition of TA to medical management v. medical management alone. ASFA guidelines recently downgraded TA for symptomatic hyperleukocytosis from Category II to III: "optimal role of TA not established", recommending individualized, patient-centered decision-making. TA for asymptomatic hyperleukocytosis remains a Category III.

TA is a common urgent apheresis consult request in patients with hyperleukocytosis. Here, the AABB’s Therapeutic Apheresis subsection sponsors a debate of this impactful topic. Two speakers will highlight the merits of their preferred, generally opposing approaches, supported by current evidence. Approximately 10 pre-submitted questions from the AABB membership at large will be addressed by the two debaters with opportunity for rebuttal, in classic debate format. In closing, real-time audience polling will gather attendees’ end-of-session, generally preferred approach.

Here, we seek to empower apheresis clinicians, trainees, and nurses to weight the risks and benefits of TA and medical management v. medical management alone in hyperleukocytosis. The main goal of the session is to support up-to-date, evidence-based, outcomes-centered care..