Patients with hyperleukocytic acute leukemia (HAL) can succumb to leukostasis. In an attempt to reduce itsincidence, 45 patients with newly diagnosed HAL and hyperleukocytosis were administered half the conventionaldose of etoposide and cytosine arabinoside (EA: 50mg/m2 daily each) until WBC counts were significantly reducedand standard induction therapy was initiated. We retrospectively reviewed their outcomes and analyzed potentialfactors with a logistic regression model. The incidence of early mortality (<30days) was 4.4% (2/45). Patientswho achieved complete remission with induction chemotherapy had significantly lower median WBC counts(26x109 L-1) after low dose EA treatment than the no response patients (median WBC: 65x109 L-1 (P<0.05).Low dose EA treatment of HAL patients reduced WBC for both lymphoid and myeloid leukemic cells and canbe considered for preemptive administration to HAL patients prior to the differential diagnosis of the acuteleukemia. This approach warrants further studies as a cytoreduction therapy for HAL.