Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2024; 23: 139-145
Приапизм в дебюте острого лимфобластного лейкоза у ребенка: описание клинического случая
https://doi.org/10.24287/1726-1708-2024-23-1-139-145Аннотация
Острый лимфобластный лейкоз (ОЛЛ) является самым распространенным онкологическим заболеванием в практике детского онколога/гематолога. При этом жизнеугрожающим осложнением в дебюте ОЛЛ может быть гиперлейкоцитоз с формированием лейкостаза с различными клиническими проявлениями. Крайне редкой формой лейкостаза у детей с ОЛЛ является ишемический приапизм. В таких случаях помимо рисков летальности, ассоциированной с гиперлейкоцитозом в рамках основного заболевания, отсутствие адекватного объема своевременной специфической и сопроводительной терапии может стать причиной эректильной дисфункции/импотенции/перемежающегося приапизма в отдаленном периоде. В статье представлено крайне редкое клиническое наблюдение ишемического приапизма у пациента 12 лет в дебюте ОЛЛ как единственного симптома заболевания, явившегося причиной обращения за медицинской помощью. Родители пациента дали согласие на использование информации, в том числе фотографий ребенка, в научных исследованиях и публикациях. В статье проанализированы особенности течения указанного осложнения с описанием современных подходов к лечению и обзором данных международной литературы. Нами подчеркнуты необходимость скоропомощного реагирования ввиду критического прогностического значения сроков и объема оказываемой медицинской помощи в составе мультидисциплинарной команды специалистов.
Список литературы
1. Hunger S.P., Mullighan C.G. Acute lymphoblastic leukemia in children. N Engl J Med 2015; 373 (16): 1541–52. DOI: 10.1056/NEJMra1400972
2. Пшонкин А.В., Румянцева Ю.В., Литвинов Д.В., Карелин А.Ф., Бойченко Э.Г., Лагойко С.Н. и др. Лечение острого лимфобластного лейкоза у подростков и молодых взрослых: опыт Москва–Берлин. Российский журнал детской гематологии и онкологии (РЖДГиО) 2016; 3 (1): 35–43. DOI: 10.17650/2311-1267-2016-3-1-35-43.
3. Ganzel C., Becker J., Mintz P.D., Lazarus H.M., Rowe J.M. Hyper-leukocytosis, leukostasis and leukapheresis: practice management. Blood Rev 2012; 26 (3): 117–22. DOI: 10.1016/j.blre.2012.01.003
4. Pham H.P., Schwartz J. How we approach a patient with symptoms of leukostasis requiring emergent leukocytapheresis. Transfusion 2015; 55 (10): 2306–11. DOI: 10.1111/trf.13210
5. Stahl M., Shallis R.M., Wei W., Montesinos P., Lengline E., Neukirchen J., et al. Management of hyper-leukocytosis and impact of leukapheresis among patients with acute myeloid leukemia (AML) on short- and long-term clinical outcomes: a large, retrospective, multicenter, international study. Leukemia 2020; 34 (12): 3149–60. DOI: 10.1038/s41375-020-0783-3
6. Spring J., Munshi L. Oncologic Emergencies: Traditional and Contemporary. Crit Care Clin 2021; 37 (1): 85–103. DOI: 10.1016/j.ccc.2020.08.004
7. Zuckerman T., Ganzel C., Tallman M.S., Rowe J.M. How I treat hematologic emergencies in adults with acute leukemia. Blood 2012; 120 (10): 1993–2002. DOI: 10.1182/blood-2012-04-424440
8. Korkmaz S. The management of hyperleukocytosis in 2017: Do we still need leukapheresis? Transfus Apher Sci 2018; 57 (1): 4–7. DOI: 10.1016/j.transci.2018.02.006
9. Porcu P., Cripe L.D., Ng E.W., Bhatia S., Danielson C.M., Orazi A., McCarthy L.J. Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation and management. Leuk Lymphoma 2000; 39 (1–2): 1–18. DOI: 10.3109/10428190009053534
10. Lichtman M.A., Rowe J.M. Hyperleukocytic leukemias: rheological, clinical, and therapeutic considerations. Blood 1982; 60 (2): 279–83.
11. Stucki A., Rivier A.S., Gikic M., Monai N., Schapira M., Spertini O. Endothelial cell activation by myeloblasts: molecular mechanisms of leukostasis and leukemic cell dissemination. Blood 2001; 97 (7): 2121–9. DOI: 10.1182/blood.v97.7.2121
12. Ganzel C., Becker J., Mintz P.D., Lazarus H.M., Rowe J.M. Hyper-leukocytosis, leukostasis and leukapheresis: practice management. Blood Rev 2012; 26 (3): 117–22. DOI: 10.1016/j.blre.2012.01.003
13. Montague D.K., Jarow J., Broderick G.A., Dmochowski R.R., Heaton J.P., Lue T.F., et al. American Urological Association guideline on the management of priapism. J Urol 2003; 170 (4 Pt 1): 1318–24. DOI: 10.1097/01.ju.0000087608.07371.ca
14. Broderick G.A., Kadioglu A., Bivalacqua T.J., Ghanem H., Nehra A., Shamloul R. Priapism: pathogenesis, epidemiology, and management. J Sex Med 2010; 7 (1 Pt 2): 476–500. DOI: 10.1111/j.1743-6109.2009.01625.x
15. Rodgers R., Latif Z., Copland M. How I manage priapism in chronic myeloid leukaemia patients. Br J Haematol 2012; 158 (2): 155–64. DOI: 10.1111/j.1365-2141.2012.09151.x
16. Vilke G.M., Harrigan R.A., Ufberg J.W., Chan T.C. Emergency evaluation and treatment of priapism. J Emerg Med 2004; 26 (3): 325–9. DOI: 10.1016/j.jemermed.2003.12.011
17. Mulhall J.P., Honig S.C. Priapism: etiology and management. Acad Emerg Med 1996; 3 (8): 810–6. DOI: 10.1111/j.1553-2712.1996.tb03520.x
18. Donaldson J.F., Rees R.W., Steinbrecher H.A. Priapism in children : a comprehensive review and clinical guideline. J Pediatr Urol 2014; 10 (1): 11–24. doi: 10.1016/j.jpurol.2013.07.024
19. Gokce A., Gul D., Orhan M.F., Büyükavci M., Demir G., Beyaz S.G. Epidural blockade for alternative management of priapism: A case report of child with T-cell acute lymphoblastic leukemia. Urology 2021; 156: e121–3. DOI: 10.1016/j.urology.2021.06.017
20. Vadakan V.V., Ortega J. Priapism in acute lymphoblastic leukemia. Cancer 1972; 30 (2): 373–75. DOI: 10.1002/1097-0142(197208)30:2<373::aid-cncr2820300211>3.0.co;2-g
21. van der Velde M.G.A.M., Tiellemans S.M..B, de Lil H., Nieuwenhuizen L. The value of leukapheresis for treatment of priapism as presenting feature of chronic myeloid leukemia-Case report and review of literature. EJHaem 2022; 3 (4): 1100–15. DOI: 10.1002/jha2.545
22. Röllig C., Ehninger G. How I treat hyperleukocytosis in acute myeloid leukemia. Blood 2015; 125 (21): 3246–52. DOI: 10.1182/blood-2014-10-551507
23. Ruggiero A., Rizzo D., Amato M., Riccardi R. Management of Hyper-leukocytosis. Curr Treat Options Oncol 2016; 17 (2): 7. DOI: 10.1007/s11864-015-0387-8
24. Ganzel C., Becker J., Mintz P.D., Lazarus H.M., Rowe J.M. Hyper-leukocytosis, leukostasis and leukapheresis: practice management. Blood Rev 2012; 26 (3): 117–22. DOI: 10.1016/j.blre.2012.01.003
25. Levey H.R., Segal R.L., Bivalacqua T.J. Management of priapism: an update for clinicians. Ther Adv Urol 2014; 6 (6): 230–44. DOI: 10.1177/1756287214542096
26. Burnett A.L., Sharlip I.D. Standard operating procedures for priapism. J Sex Med 2013; 10 (1): 180–94. DOI: 10.1111/j.1743-6109.2012.02707.x
27. Capece M., Falcone M., Cai T., Palmieri A., Cocci A., La Rocca R. Penile Prosthesis Implantation in Refractory Ischaemic Priapism: Patient Selection and Special Considerations. Res Rep Urol 2022; 14: 1–6. DOI: 10.2147/RRU.S278807
28. Reddy A.G., Alzweri L.M., Gabrielson A.T., Leinwand G., Hellstrom W.J.G. Role of Penile Prosthesis in Priapism: A Review. World J Mens Health 2018; 36 (1): 4–14. DOI: 10.5534/wjmh.17040
Pediatric Hematology/Oncology and Immunopathology. 2024; 23: 139-145
Priapism at the onset of acute lymphoblastic leukemia in a 12-year-old child
https://doi.org/10.24287/1726-1708-2024-23-1-139-145Abstract
Acute lymphoblastic leukemia (ALL) is the most common cancer in the clinical practice of pediatric oncology/hematology. At the onset of the disease, patients can develop such a life-threatening complication as hyperleukocytosis with leukostasis that can manifest in many different ways, including ischemic priapism, an extremely rare type of leukostasis in children with ALL. Apart from death associated with hyperleukocytosis caused by the underlying disease, inadequate and poorly timed specific therapy and supportive care can lead to erectile dysfunction, impotence or intermittent priapism in the future. In this article, we report an extremely rare clinical case of ischemic priapism in a 12-year-old patient that developed at the onset of ALL and was the only manifestation of the disease as well as the reason for admission to hospital. The patient's parents gave consent to the use of their child's data, including photographs, for research purposes and in publications. Here, we analyzed special aspects of this complication, described modern treatment strategies and provided an international literature review. We emphasize the importance of urgent care delivery due to the critical prognostic significance of timely and adequate treatment provided by a multidisciplinary team.
References
1. Hunger S.P., Mullighan C.G. Acute lymphoblastic leukemia in children. N Engl J Med 2015; 373 (16): 1541–52. DOI: 10.1056/NEJMra1400972
2. Pshonkin A.V., Rumyantseva Yu.V., Litvinov D.V., Karelin A.F., Boichenko E.G., Lagoiko S.N. i dr. Lechenie ostrogo limfoblastnogo leikoza u podrostkov i molodykh vzroslykh: opyt Moskva–Berlin. Rossiiskii zhurnal detskoi gematologii i onkologii (RZhDGiO) 2016; 3 (1): 35–43. DOI: 10.17650/2311-1267-2016-3-1-35-43.
3. Ganzel C., Becker J., Mintz P.D., Lazarus H.M., Rowe J.M. Hyper-leukocytosis, leukostasis and leukapheresis: practice management. Blood Rev 2012; 26 (3): 117–22. DOI: 10.1016/j.blre.2012.01.003
4. Pham H.P., Schwartz J. How we approach a patient with symptoms of leukostasis requiring emergent leukocytapheresis. Transfusion 2015; 55 (10): 2306–11. DOI: 10.1111/trf.13210
5. Stahl M., Shallis R.M., Wei W., Montesinos P., Lengline E., Neukirchen J., et al. Management of hyper-leukocytosis and impact of leukapheresis among patients with acute myeloid leukemia (AML) on short- and long-term clinical outcomes: a large, retrospective, multicenter, international study. Leukemia 2020; 34 (12): 3149–60. DOI: 10.1038/s41375-020-0783-3
6. Spring J., Munshi L. Oncologic Emergencies: Traditional and Contemporary. Crit Care Clin 2021; 37 (1): 85–103. DOI: 10.1016/j.ccc.2020.08.004
7. Zuckerman T., Ganzel C., Tallman M.S., Rowe J.M. How I treat hematologic emergencies in adults with acute leukemia. Blood 2012; 120 (10): 1993–2002. DOI: 10.1182/blood-2012-04-424440
8. Korkmaz S. The management of hyperleukocytosis in 2017: Do we still need leukapheresis? Transfus Apher Sci 2018; 57 (1): 4–7. DOI: 10.1016/j.transci.2018.02.006
9. Porcu P., Cripe L.D., Ng E.W., Bhatia S., Danielson C.M., Orazi A., McCarthy L.J. Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation and management. Leuk Lymphoma 2000; 39 (1–2): 1–18. DOI: 10.3109/10428190009053534
10. Lichtman M.A., Rowe J.M. Hyperleukocytic leukemias: rheological, clinical, and therapeutic considerations. Blood 1982; 60 (2): 279–83.
11. Stucki A., Rivier A.S., Gikic M., Monai N., Schapira M., Spertini O. Endothelial cell activation by myeloblasts: molecular mechanisms of leukostasis and leukemic cell dissemination. Blood 2001; 97 (7): 2121–9. DOI: 10.1182/blood.v97.7.2121
12. Ganzel C., Becker J., Mintz P.D., Lazarus H.M., Rowe J.M. Hyper-leukocytosis, leukostasis and leukapheresis: practice management. Blood Rev 2012; 26 (3): 117–22. DOI: 10.1016/j.blre.2012.01.003
13. Montague D.K., Jarow J., Broderick G.A., Dmochowski R.R., Heaton J.P., Lue T.F., et al. American Urological Association guideline on the management of priapism. J Urol 2003; 170 (4 Pt 1): 1318–24. DOI: 10.1097/01.ju.0000087608.07371.ca
14. Broderick G.A., Kadioglu A., Bivalacqua T.J., Ghanem H., Nehra A., Shamloul R. Priapism: pathogenesis, epidemiology, and management. J Sex Med 2010; 7 (1 Pt 2): 476–500. DOI: 10.1111/j.1743-6109.2009.01625.x
15. Rodgers R., Latif Z., Copland M. How I manage priapism in chronic myeloid leukaemia patients. Br J Haematol 2012; 158 (2): 155–64. DOI: 10.1111/j.1365-2141.2012.09151.x
16. Vilke G.M., Harrigan R.A., Ufberg J.W., Chan T.C. Emergency evaluation and treatment of priapism. J Emerg Med 2004; 26 (3): 325–9. DOI: 10.1016/j.jemermed.2003.12.011
17. Mulhall J.P., Honig S.C. Priapism: etiology and management. Acad Emerg Med 1996; 3 (8): 810–6. DOI: 10.1111/j.1553-2712.1996.tb03520.x
18. Donaldson J.F., Rees R.W., Steinbrecher H.A. Priapism in children : a comprehensive review and clinical guideline. J Pediatr Urol 2014; 10 (1): 11–24. doi: 10.1016/j.jpurol.2013.07.024
19. Gokce A., Gul D., Orhan M.F., Büyükavci M., Demir G., Beyaz S.G. Epidural blockade for alternative management of priapism: A case report of child with T-cell acute lymphoblastic leukemia. Urology 2021; 156: e121–3. DOI: 10.1016/j.urology.2021.06.017
20. Vadakan V.V., Ortega J. Priapism in acute lymphoblastic leukemia. Cancer 1972; 30 (2): 373–75. DOI: 10.1002/1097-0142(197208)30:2<373::aid-cncr2820300211>3.0.co;2-g
21. van der Velde M.G.A.M., Tiellemans S.M..B, de Lil H., Nieuwenhuizen L. The value of leukapheresis for treatment of priapism as presenting feature of chronic myeloid leukemia-Case report and review of literature. EJHaem 2022; 3 (4): 1100–15. DOI: 10.1002/jha2.545
22. Röllig C., Ehninger G. How I treat hyperleukocytosis in acute myeloid leukemia. Blood 2015; 125 (21): 3246–52. DOI: 10.1182/blood-2014-10-551507
23. Ruggiero A., Rizzo D., Amato M., Riccardi R. Management of Hyper-leukocytosis. Curr Treat Options Oncol 2016; 17 (2): 7. DOI: 10.1007/s11864-015-0387-8
24. Ganzel C., Becker J., Mintz P.D., Lazarus H.M., Rowe J.M. Hyper-leukocytosis, leukostasis and leukapheresis: practice management. Blood Rev 2012; 26 (3): 117–22. DOI: 10.1016/j.blre.2012.01.003
25. Levey H.R., Segal R.L., Bivalacqua T.J. Management of priapism: an update for clinicians. Ther Adv Urol 2014; 6 (6): 230–44. DOI: 10.1177/1756287214542096
26. Burnett A.L., Sharlip I.D. Standard operating procedures for priapism. J Sex Med 2013; 10 (1): 180–94. DOI: 10.1111/j.1743-6109.2012.02707.x
27. Capece M., Falcone M., Cai T., Palmieri A., Cocci A., La Rocca R. Penile Prosthesis Implantation in Refractory Ischaemic Priapism: Patient Selection and Special Considerations. Res Rep Urol 2022; 14: 1–6. DOI: 10.2147/RRU.S278807
28. Reddy A.G., Alzweri L.M., Gabrielson A.T., Leinwand G., Hellstrom W.J.G. Role of Penile Prosthesis in Priapism: A Review. World J Mens Health 2018; 36 (1): 4–14. DOI: 10.5534/wjmh.17040
