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Jaksic W, Veljkovic D, Pozza C, Lewis I. Methotrexate-induced leukoencephalopathy reversed by aminophylline and high-dose folinic acid. Acta Haematol 2004; 111:230-2. [PMID: 15153718 DOI: 10.1159/000077573] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2003] [Accepted: 12/02/2003] [Indexed: 11/19/2022]
Affiliation(s)
- Wilfrid Jaksic
- Department of Haematology/Oncology, Queen Elizabeth Hospital, Woodville, Australia.
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Vlacha V, Eliopoulou M, Haidas S, Beratis NG. Correlation of cerebrospinal fluid beta-glucuronidase activity with plasma methotrexate concentrations in leukemic children receiving high-dose methotrexate. Pediatr Blood Cancer 2004; 42:350-6. [PMID: 14966832 DOI: 10.1002/pbc.20002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The activity of lysosomal enzymes is increased in body fluids during inflammation, in which cellular malfunction and cellular death occurs. Because chemotherapy also causes cell malfunction and death, for identifying a neurologic effect, we studied the activity of beta-glucuronidase in the cerebrospinal fluid (CSF) of leukemic children during treatment. PROCEDURE The beta-glucuronidase activity in CSF was determined in 13 patients with B-precursor acute lymphoblastic leukemia (ALL) treated with the medium risk arm of ALL Berlin-Frankfurt-Munster (BFM) 95 protocol. Plasma methotrexate (MTX) levels were determined at 24 and 48 hr after the infusion of high-dose (5 g/m(2)/24 hr) MTX (MCA phase). RESULTS The mean (SD) beta-glucuronidase activity prior to the onset of chemotherapy was 19.9 (5.6) nmoles/4-methylumbelliferone/ml/hr. No significant changes in activity were noted during the phases of the protocol except of the MCA3. The activity was 24.4 (6.8) on MCA2, 28.4 (9.3) on MCA3, and 24.1 (9.5) on MCA4. The beta-glucuronidase activity was positively correlated with the plasma MTX levels at both 24 hr (r = 0.483, P = 0.006) and 48 hr (r = 0.676, P < 0.0001). No progressive changes were noted during the different phases of the protocol. The greatest beta-glucuronidase activity was measured in two patients with neurotoxicity. CONCLUSIONS The beta-glucuronidase activity is increased in the CSF of leukemic children receiving high-dose MTX and particularly in neurotoxicity. It is positively correlated with plasma MTX levels. No cumulative effect of the chemotherapy was observed. The increased beta-glucuronidase activity is most likely due to enzyme leakage through the cell membranes caused mainly by a toxic effect of MTX on the cells of the central nervous system (CNS).
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Affiliation(s)
- Vasiliki Vlacha
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Patras, School of Medicine, General University Hospital, Patras, Greece.
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Dahéron L, Brizard F, Millot F, Cividin M, Lacotte L, Guilhot F, Brizard A. E2A/HLF fusion gene in an acute lymphoblastic leukemia patient with disseminated intravascular coagulation and a normal karyotype. Hematol J 2003; 3:153-6. [PMID: 12111652 DOI: 10.1038/sj.thj.6200169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2000] [Accepted: 02/08/2001] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Disseminated intravascular coagulation (DIC) is a rare event in acute lymphoblastic leukemia (ALL). However, it has been described in a few cases of pre-B ALL with translocation t(17;19)(q22;p13) which results in the fusion of E2A gene with sequences of HLF gene. Here, we report a case of pre-B ALL with DIC and an apparently normal karyotype by R banding. MATERIALS AND METHODS Fluorescent in situ hybridization (FISH) studies were performed on bone marrow cells from the patient at presentation and after three months of therapy. RT-PCR was used to detect the E2A-HLF transcript. The type of rearrangement was characterized by sequencing. RESULTS The t(17;19)(q22;p13) was detected by FISH analysis. The fusion E2A-HLF was amplified by RT-PCR and sequenced, giving a type I rearrangement with a long insertion (146 nucleotides) between E2A exon 13 and HLF exon 4. CONCLUSION While translocation t(17;19) is undetectable by R-banding technique, it can be detected with FISH and amplified with RT-PCR. Therefore, systematic molecular investigations should be conducted for all patients with pre-B ALL associated with DIC, in order to appreciate the incidence and the prognostic value of this rare abnormality.
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Affiliation(s)
- Laurence Dahéron
- Laboratoire d'Hématologie (CNRS FRE 2224), Poitiers University Hospital, France
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Gerotziafas GT, Zervas C, Gavrielidis G, Tokmaktsis A, Hatjiharissi E, Papaioannou M, Lazaridou A, Constantinou N, Samama MM, Christakis J. Effective hemostasis with rFVIIa treatment in two patients with severe thrombocytopenia and life-threatening hemorrhage. Am J Hematol 2002; 69:219-22. [PMID: 11891811 DOI: 10.1002/ajh.10056] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report two patients with severe thrombocytopenia and life-threatening bleeding that were successfully managed with recombinant activated factor VII (rFVIIa). The first was a 75-year-old male with Waldenström's macroglobulinemia. During a therapeutic course with fludarabine, he developed severe autoimmune thrombocytopenia resistant to conventional treatment, followed by persistent uncontrollable nasal bleeding. Platelet transfusions failed to increase the platelet count and control the hemorrhage. When hemoglobin levels fell below 8.5 g/dL and the patient's clinical condition got much worse, a single dose of 4.8 mg rFVIIa (90 microg/kg) was given as an i.v. bolus. Ten minutes after the rFVIIa injection, nasal bleeding stopped, the patient's clinical condition progressively improved, and splenectomy could be carried out uneventfully 2 days later. The second patient, a 52-year-old female, was under treatment for pre-B lymphoblastic leukemia. She developed severe thrombocytopenia, secondary to chemotherapy, complicated by massive gastrointestinal bleeding. Despite intensive treatment with platelet transfusions, hemorrhage continued and her condition deteriorated rapidly. She was then given an i.v. bolus injection of 4.8 mg rFVIIa, which resulted in cessation of hemorrhage and dramatic improvement of her clinical status. No adverse effects from the treatment with rFVIIa were observed. In conclusion, rFVIIa appears to be an attractive alternative for controlling hemorrhage in patients with severe thrombocytopenia, especially when platelet transfusions are unavailable or ineffective.
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Kawa K, Okamura T, Yagi K, Takeuchi M, Nakayama M, Inoue M. Mosquito allergy and Epstein-Barr virus-associated T/natural killer-cell lymphoproliferative disease. Blood 2001; 98:3173-4. [PMID: 11721684 DOI: 10.1182/blood.v98.10.3173] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Buxhofer V, Ruckser R, Kier P, Habertheuer KH, Tatzreiter G, Zelenka P, Dorner S, Sebesta C, Knosp E, Hruby W, Hinterberger W. Successful treatment of invasive mould infection affecting lung and brain in an adult suffering from acute leukaemia. Eur J Haematol 2001; 67:128-32. [PMID: 11722602 DOI: 10.1034/j.1600-0609.2001.t01-1-00461.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe in detail a 67-yr-old woman who was treated with a cytostatic combination chemotherapy for newly diagnosed common-acute lymphoblastic leukaemia. At the end of induction therapy, the patient acquired invasive mould infection affecting lung and brain. The patient entered complete remission of her leukaemia. Treatment with liposomal amphotericin B was initiated along with surgical excision of the fungal brain abscess. Intrathecal instillation of amphotericin B deoxycholate was started using an Ommaya reservoir because of an anatomical connection between the postoperative cavity and the ventricle. Full dose cytostatic chemotherapy was continued with little delay. A computerised tomography scan of the chest performed 2 months later revealed no fungal abscesses. Magnetic resonance imaging of the brain did not reveal any fungal manifestation. During maintenance therapy/week 69, the patient relapsed from leukaemia. High doses of intravenous liposomal amphotericin B were administered prophylactically. The patient's leukaemia proved refractory to reinduction chemotherapy and the patient died from pneumonia 8 wk later. Post mortem microbiological investigation and histopathological examination of lung and brain tissue did not reveal any macroscopical or microscopical fungal manifestations. This case underlines the feasibility and successful application of combined antileukaemic, antifungal and surgical therapy in a patient with acute leukaemia.
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Affiliation(s)
- V Buxhofer
- Second Department of Medicine, Ludwig Boltzmann Institute for Stem Cell Transplantation, Danube Hospital, Vienna, Austria.
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Abstract
PURPOSE Hepatic dysfunction is a rare presentation of leukemia in children. Because most chemotherapy agents are metabolized by the liver, this complication may have major adverse consequences and effective treatment could be compromised. PATIENTS AND METHODS The MEDLINE database and current management guidelines from the United States Pediatric Cooperative Cancer Groups were reviewed and analyzed. Data from two institutional cases are described. RESULTS Although previous literature is not informative, our experience suggests that children with leukemia and moderate hepatic dysfunction may tolerate aggressive chemotherapy. CONCLUSION Current protocol guidelines for dose modification for liver disease may be overly stringent and modification may be beneficial.
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Affiliation(s)
- J F Kelleher
- Department of Pediatrics, Baystate Medical Center, Springfield, Massachusetts, USA
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58
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Abstract
We would like to report the use of liposomal amphotericin in eradicating mucormycosis in two patients who had relapsed acute leukaemia. The first patient with relapsed acute myeloid leukaemia developed a rapidly expanding solitary necrotic neck lesion associated with opacity of maxilliary sinus at a time when he was profoundly pancytopenic following high dose chemotherapy. The second patient was a 3-year-old boy with pre-B acute lymphoblastic leukaemia who developed a central nervous system relapse whilst on his first line treatment and was treated with more aggressive chemotherapy on the Medical Research Council Relapse Protocol. During a period of profound pancytopenia following re-induction therapy, including high dose steroids and prolonged course of antibiotics for proven septicaemia, he developed periorbital swelling and proptosis and a clinical diagnosis of rhinocerebral mucormycosis was made. Both patients were treated with high doses of liposomal amphotericin (Ambisome Nexstar). The doses were escalated to 10 and 15 mg/kg/day, resulting in successful eradication of the mucormycosis.
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Affiliation(s)
- T Parkyn
- Department of Paediatrics, Royal Devon and Exeter Hospital, Exeter, UK
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Affiliation(s)
- R Arav-Boger
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Erduran E, Arslan MK, Dereci S. Acalculous cholecystitis caused by Salmonella paratyphi B infection in a child with acute pre-B-cell lymphoblastic leukemia. Pediatr Hematol Oncol 1999; 16:473-6. [PMID: 10505326 DOI: 10.1080/088800199277056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Acute acalculous cholecystitis (AC) rarely occurs in children with acute leukemia. The principal treatment modality of AC is emergency surgery. Medical treatment of AC is not a good therapeutic approach. The mortality rate of AC is approximately 100% for medical treatment and 10-15% for emergency surgery. A 9-year-old boy with acute pre-B-cell lymphoblastic leukemia and AC caused by Salmonella paratyphi B infection is presented. He was successfully treated with cefepime, amikacin, and granulocyte-colony stimulating factor (G-CSF). These treatment combinations led to uneventful recovery after 21 days. It appears that AC in children with acute leukemia may be treated with appropriate intravenous antibiotics. This may be the first case of AC caused by Salmonella paratyphi B infection reported in a child with acute pre-B-cell lymphoblastic leukemia.
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Affiliation(s)
- E Erduran
- Department of Pediatrics and General Surgery, Karadeniz Technical University, Trabzon, Turkey.
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Affiliation(s)
- D Devictor
- Unité de soins intensifs pédiatriques, Hôpital de Bicêtre, France
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Abstract
BACKGROUND As opposed to large-cell or Burkitt's-type non-Hodgkin's lymphoma, acute lymphoblastic leukemia (ALL) is rarely observed in HIV-seropositive patients and is not a criteria of AIDS in the 1986 classification established by the C.D.C. Furthermore, the few cases of ALL reported so far were B-cell ALL, Burkitt's-type. DESIGN We recently observed, with unexpected frequency, ALL cases in this setting: over a 5-year period, 5 of 25 HIV-positive patients referred to our center for hematological malignancies, had ALL. Three patients, who had previously been asymptomatic with regard to HIV infection, had typical Burkitt's-type ALL. Complete remission was achieved in all cases with high-dose lymphoma-type chemotherapy regimens, but 2 patients relapsed 3 and 27 months after diagnosis. Their clinical characteristics and outcome are discussed with reference to the cases reported thus far in the literature. One patient had common early pre-B ALL with the Philadelphia chromosome, and one had a T-cell ALL with an unusual CD7+, CD4-, CD8- phenotype. Prognosis was very poor in both cases. CONCLUSION The exact incidence and the therapeutic management of B-cell ALL in HIV-positive patients warrants further evaluation. In addition, we show that there may be a heterogeneity among ALL cases in this setting, with the first description of 2 non-Burkitt's ALL with atypical features in HIV-positive patients.
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Affiliation(s)
- L Gérinière
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
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63
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Grauer ME, Bokemeyer C, Welte T, Freund M, Link H. Successful treatment of Mucor pneumonia in a patient with relapsed lymphoblastic leukemia after bone marrow transplantation. Bone Marrow Transplant 1993; 12:421. [PMID: 8275045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Pullen J, Boyett J, Shuster J, Crist W, Land V, Frankel L, Iyer R, Backstrom L, van Eys J, Harris M. Extended triple intrathecal chemotherapy trial for prevention of CNS relapse in good-risk and poor-risk patients with B-progenitor acute lymphoblastic leukemia: a Pediatric Oncology Group study. J Clin Oncol 1993; 11:839-49. [PMID: 8487048 DOI: 10.1200/jco.1993.11.5.839] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE The Pediatric Oncology Group (POG) acute leukemia in childhood (ALinC) 13 study tested two treatment regimens that used different CNS chemoprophylaxis for children older than 12 months with non-T, non-B acute lymphoblastic leukemia (ALL) and with no demonstrable CNS disease at diagnosis. PATIENTS AND METHODS With the first regimen, standard (S), six injections of triple intrathecal chemotherapy (TIC), consisting of methotrexate (MTX), hydrocortisone (HC), and cytarabine (ara-C), were administered during intensification treatment and at every-8-week intervals throughout the maintenance phase for 17 additional doses. The second regimen, standard and MTX pulses (SAM), also specified six TICs during intensification, but substituted every-8-week pulses of intermediate-dose parenteral methotrexate (IDM; 1 g/m2) for the 17 maintenance TIC injections, with a low-dose intrathecal (IT) MTX boost administered with the first four maintenance IDM pulses. Otherwise, systemic therapy on regimen SAM was identical to regimen S. There were 1,152 patients randomized to the S and SAM regimens after stratification by risk group (age/leukocyte count) and immunophenotype. RESULTS The 5-year probabilities (+/- SE) of an isolated CNS relapse were regimen S: good risk (n = 381), 2.8% +/- 1.3%; poor risk (n = 196), 7.7% +/- 3.2%; good + poor risk (n = 577), 4.7% +/- 1.5%; regimen SAM: good risk (n = 388), 9.6% +/- 2.2%; poor risk (n = 187), 12.7% +/- 4.2%; good + poor risk (n = 575), 10.9% +/- 2.2%. In poor-risk patients, approximately one third of the isolated CNS relapses occurred before preventive CNS therapy was begun at week 9. Hence, regimen S has provided better CNS preventive therapy for both good- and poor-risk patients (P < .001 overall). The difference is statistically significant for good-risk patients (P < .001), but not for poor-risk patients (P = .20). Neither treatment has shown a significant advantage in terms of general outcome. CONCLUSION TIC injections extended throughout the intensification and maintenance periods are superior to IDM pulses for prevention of CNS leukemia. Our results with TIC seem comparable with those achieved with other contemporary methods of CNS preventative therapy. Thus, extended TIC affords a reasonable alternative to CNS irradiation plus upfront IT MTX for patients with B-progenitor ALL.
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Affiliation(s)
- J Pullen
- University of Mississippi, Jackson
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65
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Affiliation(s)
- D Fisher
- Kanematsu Laboratories, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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66
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Abstract
Using repeated computed tomographic and magnetic resonance imaging scans, we examined 8 patients with acute lymphocytic leukemia during remission induction therapy between 1988 and 1989. In 3 patients, leukoencephalopathy was diagnosed by T2-weighted magnetic resonance imaging. In 1 patient, leukoencephalopathy was progressive and irreversible brain damage and mental retardation persisted. In the other 2 patients, hyperintense lesions in the periventricular white matter were transient and no neurologic sequelae ensued. Magnetic resonance imaging was more useful than computed tomography in the early diagnosis and management of these acute lymphocytic leukemia patients with leukoencephalopathy.
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Affiliation(s)
- M Ito
- Department of Pediatrics, Shimane Medical University, Izumo, Japan
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Rivera GK, Raimondi SC, Hancock ML, Behm FG, Pui CH, Abromowitch M, Mirro J, Ochs JS, Look AT, Williams DL. Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy. Lancet 1991; 337:61-6. [PMID: 1670723 DOI: 10.1016/0140-6736(91)90733-6] [Citation(s) in RCA: 266] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To improve outcome in childhood acute lymphoblastic leukaemia (ALL), a stratified, randomised study of extended intensified chemotherapy was done. 358 evaluable patients received remission reinforcement therapy (teniposide, cytarabine, high-dose methotrexate) added to a four-drug induction regimen. Those achieving complete remission were randomised on the basis of risk group assignment to conventional continuation treatment or to four pairs of drugs rotated weekly or every 6 weeks. All patients received intrathecal chemotherapy; higher-risk patients also received 1800 cGy cranial irradiation after 1 year of remission. Complete remission was induced in 96% of the patients. At median follow-up of 40 (range 19-73) months, 4-year event-free survival (SE) was 73 (4)% overall, 81 (6)% in the lower-risk group (n = 110), and 69 (5)% in the higher-risk group (n = 248). Outcome within risk groups was not significantly affected by the speed of rotation of drug pairs during continuation treatment. Various high-risk subgroups had apparently improved responses to this treatment. This intensified chemotherapy may cure 69-77% of children with ALL.
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Affiliation(s)
- G K Rivera
- Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee 38101-0318
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Castaman G, Rodeghiero F, Dini E. Thrombotic complications during L-asparaginase treatment for acute lymphocytic leukemia. Haematologica 1990; 75:567-9. [PMID: 2098299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We report 2 new cases of thrombosis occurring in a cohort of 21 consecutive patients with acute lymphocytic leukemia treated with L-asparaginase (L-ase), 6,000 U/die s.c. or i.m. days 15-21 from start of chemotherapy, according to the GIMEMA LAL 0288 protocol. The first patient died of massive diffuse thromboembolism (thrombosis of sagittal sinus and of suprahepatic veins and pulmonary arteries; multiple hepatic and splenic infarctions) associated with markedly reduced levels of protein C, antithrombin III and plasminogen. In the second patient, portal vein thrombosis developed soon after the completion of L-ase. Antithrombin III was reduced, whereas protein C level was normal. Therapy with fresh frozen plasma and subcutaneous calcium heparin (12,500 U twice daily) proved successful, and 8 days later abdominal echotomography revealed the complete disappearance of the thrombus. The incidence of thrombosis is similar to that previously found in a cohort of consecutive patients treated at our Department with a different schedule and dosage of L-ase administration, and similar to that reported in previous series.
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Affiliation(s)
- G Castaman
- Dipartimento di Ematologia, Ospedale San Bortolo, Vicenza, Italy
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Baumgarten E, Fengler R, Brockmeier K, Domeyer C, Schulte-Overberg U, Schmid HJ, Scheffner D, Henze G. Syndrome of the posterior and anterior root in a late isolated CNS relapse of c-ALL. Case report. Neurosurg Rev 1990; 13:73-5. [PMID: 2320272 DOI: 10.1007/bf00638898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 15 year-old girl who had c-ALL diagnosed in 1982 was presented in our clinic suffering from an ascended flaccid paresis and dysaesthesia of both legs. These are typical symptoms of polyradiculitis of the nerve roots L2-S2. A lumbal puncture revealed a pleocytosis with lymphoblasts which were up to 40% CD10 (cluster of differentiation) up to 70% CD19 and TdT (terminal transferase) positive. The diagnosis of late isolated CNS relapse was made. It is assumed that local residual infiltrations of leukemic cells into the nerve roots L2-S2 got into cell cycle and caused these rare CNS leukemia symptoms. Therefore the value of a craniospinal irradiation to prevent a CNS and systemic relapse is discussed.
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Affiliation(s)
- E Baumgarten
- Department of Paediatrics, Free University of Berlin, West Germany
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Affiliation(s)
- A Stein
- Department of Haematology, Queen Elizabeth Hospital, Birmingham
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