Comparison of early mortality between leukapheresis and non-leukapheresis in adult acute myeloid leukemia patients with hyperleukocytosis: a systematic review and meta-analysis

Figures & data

Figure 1. Study selection flowchart based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram.

Table 1. Characteristics of included studies.

Author	Year	Country	Study design	Sample size (n)	Treatment and comparator	Median age (years)	Median Hb (g/dL)	Blast (%)	Median leukocyte (/µL)	Median platelet (/µL)	Hyperleukocytosis cutoff (/mm^3)	Leukostasis (%)	Early mortality outcomes
Bug et al. [23]	2007	Germany	Retrospective Cohort	53	Leukapheresis Non-leukapheresis	49.9 49.4	9.4 8.9	N/A N/A	186,000 166,000	57,000 49,000	100,000	52 43	21-day mortality
Choi et al. [24]	2018	Korea	Matching Retrospective Cohort	44	Leukapheresis Non-leukapheresis	52 56	7.6 6.8	83 88	186,000 142,000	59,000 53,000	100,000	N/A N/A	14-day mortality
Kuo et al. [25]	2014	Canada	Retrospective Cohort	88	Leukapheresis Non-leukapheresis	N/A N/A	N/A N/A	N/A N/A	N/A N/A	N/A N/A	100,000	N/A N/A	28-day mortality
Malkan et al. [43]	2017	Turkey	Retrospective Cohort	28	Leukapheresis Non-leukapheresis	48 54.5	9.05 8.95	N/A N/A	152,500 128,500	44,500 42,000	100,000	40 N/A	15-day mortality
Martínez-Cuadrón et al. [26]	2013	Spain	Retrospective Cohort	54	Leukapheresis Non-leukapheresis	55 63	9.1 9.7	N/A N/A	198,000 189,000	38,000 53,000	95,000	61 50	28-day mortality 21-day mortality 14-day mortality 7-day mortality
Nan et al. [22]	2016	USA	Retrospective Cohort	52	Leukapheresis Non-leukapheresis	60 64.5	8.3 9.2	75 75	163,500 101,300	22,500 36,000	50,000	85 65	28-day mortality
Pastore et al. [27]	2014	Germany	Retrospective Cohort	52	Leukapheresis Non-leukapheresis	62 60	N/A N/A	N/A N/A	208,000 142,000	N/A N/A	100,000	N/A N/A	28-day mortality 7-day mortality
Rinaldi et al. [30]	2021	Indonesia	Retrospective Cohort	38	Leukapheresis Non-leukapheresis	40.82 43.11	6.694 7.866	90% 90%	353,830 170,930	57,900 34,000	100,000	100 100	28-day mortality
Shallis et al. [13]	2020	USA	Retrospective Cohort	189	Leukapheresis Non-leukapheresis	N/A N/A	N/A N/A	N/A N/A	N/A N/A	N/A N/A	50,000	Only available for n: 219	30-day mortality
Stahl et al. [28]	2020	USA and Europe	Retrospective Cohort	779	Leukapheresis Non-leukapheresis	55 55	9.3 9.2	82.5 74	175,000 103,000	46,500 31,000	50,000	56 27	30-day mortality
Wong[44]	2015	Singapore	Retrospective cohort	54	Leukapheresis Non-leukapheresis	N/A N/A	N/A N/A	N/A N/A	N/A N/A	N/A N/A	100,000	N/A N/A	30-day mortality

Figure 2. Early mortality outcome from studies using hyperleukocytosis cutoff ≥ 95,000/mm³ or 100,000/mm³.

Figure 3. Early mortality outcome from studies using hyperleukocytosis cutoff ≥ 50,000/mm³.

Figure 4. Pooled analysis for 7-day mortality.

Figure 5. Funnel plot.

Figure 6. Summary of risk of bias from eligible studies.

Figure 7. Intra-study analysis of risk of bias. Legend: green circle-low risk of bias; yellow-circle unclear risk of bias; red circle-high risk of bias.

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