424P - The Storm: Paraneoplastic leucomoid reaction - A bad prognostic factor

Background

Paraneoplastic leucomoid reaction (PLR) is well described entity where white blood cell (WBC) count increase ≥50000/mm³ in association with malignancy.It is known to be predictive of poor prognosis.Recent research works have demonstrated that there are relationships between PLR activated by intratumoral production of granulocyte colony stimulatory factor (G-CSF), the RAS/RAF/MEK pathway and tumorogenesis. It may even seen before diagnosis of malignancy. It is too important to understand the cause of high WBC count to start specific proper treatment or change treatment protocol because many clinicians delayed to start treatment that harmful for patients.

Methods

The study was an observational study. Study period was January 2022 to June 2022.

Results

Of total 350 patients, PLR was found in only 24 (6.86%).Age range of patients were from 32 years to 85 years and average was 60 years. Among them, carcinoma lung 6(25%) where 4(66.66%) patients were metastatic to liver and 2(33.33%) patient had localized disease; carcinoma gall bladder 4(16.66%) where 4(100%) had metastasis to liver; carcinoma unknown primary 4(16.66%); carcinoma buccal mucosa 4(16.66%); carcinoma cervix 2(8.33%); metastatic prostate cancer 2(8.33%) and carcinoma urinary bladder 2(8.33%).Infections were ruled out methodically by culture and sensitivity of blood, urine, bone marrow but none showed any growth. 14(58.33%) patients were on specific treatment and 41.67%) patients were on supportive management after PLR develop. 23(95.83%) patients developed PLR after diagnosis of cancer or during cancer treatment or many days thereafter. Only 1(4.17%) patient developed PLR before diagnosis of malignancy. WBC count ≥50000/mm³ were found in 23(95.83%) and only 1(4.67%) patient had 45000/ mm³. Neutrophil count ≥90% were documented in 14(58.33%) patients and ≥85% in 10(41.67%). Platelet count were found high in 12(50%). Bone marrow examinations16(66.67%) showed Neutrophilic leucocytosis in 14(87.5%) patients.Death from development of PLR from 4 days to 240 days and average time of death was documented within 72 days.

Conclusions

In developing countries, patients were underwent investigations repeatedly for a long period for PLR that delayed diagnosis, ultimately delayed treatment and we lost patients.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Abdullah Al Mamun Khan.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.