Risk Factors and Outcomes of Hyperleukocytosis In Pediatric Acute Leukemia: A Five-Year Retrospective Case-Control Study at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia.
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Date
2026-03-13
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Addis Ababa University
Abstract
Background: Hyperleukocytosis is a pediatric oncologic emergency in acute leukemia associated with leukostasis, tumor lysis syndrome, and early mortality. Despite its clinical importance, the data on risk factors and outcomes of hyperleukocytosis in children with acute leukemia are limited in low-resource settings.
Objective: To identify risk factors and early outcomes of hyperleukocytosis among pediatric acute leukemia patients at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia.
Methods: A five-year case-control study took place at the pediatric hematology-oncology unit of Tikur Anbesa Specialized Hospital from April 1, 2020, to March 31, 2025. The study included children under 18 years with newly diagnosed acute leukemia. Cases were patients with hyperleukocytosis (white blood cell count ≥100,000/μL) at diagnosis, and controls were patients without hyperleukocytosis in a 1:2 ratio. Researchers collected data using a structured checklist and analyzed it with SPSS version 29. They calculated descriptive statistics and made comparisons between groups using chi-square and Mann-Whitney U tests. They used multivariable logistic regression analysis to find independent risk factors and predictors of early mortality. The study reported adjusted odds ratios (AOR) with 95% confidence intervals, and a p-value of less than 0.05 was considered statistically significant.
Results: A study of 153 patients diagnosed with pediatric acute leukemia indicated that 51 of these patients presented with hyperleukocytosis and the remaining 102 served as the control group for this study. The association between hyperleukocytosis at the time of presentation and respiratory symptoms, peripheral blast percentage, uric acid concentration, and leukemia subclass was found to be statistically significant. Multivariate analysis demonstrated that respiratory symptoms (AOR = 5.74), acute myeloid leukemia (AOR = 4.23), peripheral blast percentage (AOR = 1.045), and uric acid level (AOR = 1.213) were independent risk factors for hyperleukocytosis. Patients with hyperleukocytosis had significantly more complications than patients without hyperleukocytosis (88.2% vs 57.8%) and greater than the patients without hyperleukocytosis (25.5% vs 5.9%). Our study further demonstrated that hyperleukocytosis (AOR = 19.31), respiratory symptoms (AOR = 10.37), low platelet count (AOR = 0.942), and elevated uric acid (AOR = 1.302) were independent predictors of early mortality.
Conclusion: Pediatric acute leukemia patients who have hyperleukocytosis, have a much higher risk of developing 10
complications and dying shortly thereafter. The factors that independently predict response to treatment in these patients include respiratory symptoms, AML type, high number of peripheral blasts in the blood, and the presence of elevated uric acid levels. To reduce mortality in any sub-group of high-risk patients, they need to be identified early, and appropriate supportive care should be started quickly.
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Keywords
Hyperleukocytosis, Pediatric acute leukemia, Case-control study, Risk factors, Early mortality, Ethiopia.