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PubMed1978

A case of acute myelogenous leukemia with an 8--21 translocation, missing Y, and additional karyotypic abnormalities.

A patient with acute myelogenous leukemia (AML) whose bone marrow cells had complicated chromosomal abnormalities, in addition to an 8--21 translocation and a missing Y chromosome, is reported. The complex additional abnormalities did not appear to have much influence on the clinical aspects of the disease, eg, cytology of the leukemic cells and the patient's response to chemotherapy, even though the patient did have a rectal tumor due to leukemic cell infiltration.

Adult↗
PubMed1987

Isolated leukemia cutis--a case report.

A 67-year-old woman with acute myelomonocytic leukemia had a clinical course characterized by the initial appearance of leukemia cutis without bone marrow involvement. When marrow involvement subsequently occurred, induction chemotherapy cleared all manifestations of the illness. Shortly thereafter, while blood and bone marrow remained in remission, the skin lesions reappeared. The introduction of 6-thioguanine, as part of the maintenance treatment protocol, resulted in the rapid and permanent disappearance of the leukemic skin infiltrates.

Aged↗
PubMed1993

High incidence of meningeal leukemia in lymphoid blast crisis of chronic myelogenous leukemia.

Fifteen patients with lymphoid blast crisis of chronic myelogenous leukemia (LyBC-CML) and five patients with acute lymphoblastic leukemia converting to Philadelphia-positive (Ph+) chronic myeloid leukemia (ALL Ph + CML) were followed. Seven of 15 (46.7%) LyBC-CML patients developed meningeal leukemia within a median period of 6 months (range 2-11 months), while there was no medullary relapse. Five of these responded well to triple intrathecal therapy. In the ALL Ph + CML patients, in spite of central nervous system (CNS) prophylaxis with IT MTX and 18 Gy cranial radiation, two of five patients (40%) experienced meningeal leukemia, one isolated and the other with medullary relapse. The data confirm that LyBC-CML patients experience a high incidence of meningeal leukemia. The role of CNS prophylaxis is not very clear, but its use may delay development and reduce morbidity due to CNS disease.

Blast Crisis↗
PubMed1993

Power of the MAC (morphology-antibody-chromosomes) method in distinguishing reactive and clonal cells: report of a patient with acute lymphatic leukemia, eosinophilia, and t(5;14).

We present a patient with acute lymphatic leukemia, eosinophilia, and a 5;14-translocation, a rare but well-documented condition. In order to clarify whether granulocytes were involved in the disease, we applied the MAC (Morphology-Antibody-Chromosomes) technique to samples of the bone marrow and, during a central nervous system relapse, to those of the cerebrospinal fluid. The karyotype of the blast cells was 47,XY, + X,t(5;14)(q31;q32),i(7)(q10). Interphase cytogenetic study by in situ hybridization with an X-specific alphoid probe revealed the abnormality in CD10, CD19, and TdT (terminal deoxynucleotidyl transferase) positive lymphoid cells, whereas CD13 positive, Sudan black B positive, eosinophilic, and basophilic granulocytes as well as monocytes and small lymphocytes did not have the abnormality. Our results show that the eosinophilic and basophilic granulocytes in this subtype of acute leukemia do not belong to the malignant clone but are reactive. This study also confirmed the usefulness of the MAC technique in distinguishing neoplastic and reactive cells in malignancy.

Adult↗
PubMed1994

Leukemic ophthalmopathy: a report of 21 pediatric cases.

A multicentric retrospective study on leukemic ophthalmopathy (LO) is reported. It includes 21 patients, 16 males and 5 females, with acute leukemia (AL) observed in 10 SIOP centers. LO developed in three patients at the time of diagnosis of AL; five patients were in first complete remission (three off therapy); four patients were in second or third remission; and nine were in combined relapse. Most frequent symptoms were blurred vision, photophobia, and ocular pain. Two patients with acute nonlymphoblastic leukemia died before treatment; another underwent bone marrow transplantation; one patient with B-cell acute lymphoblastic leukemia (B-ALL) treated with chemotherapy and radiotherapy died 4 months after LO; the remaining 17 children were treated according to different schedules with (10) or without (7) radiotherapy on the affected eye. Twelve patients achieved ocular remission and four of these had a second ocular relapse. Complete remission after LO treatment lasting for more than 3, 7, 24, 29 months was observed in four patients. The authors conclude that cure is possible in patients who had LO in first complete remission treated with chemotherapy and radiotherapy at high dose on the affected eye.

Acute Disease↗
PubMed1994

Isolated bone relapse during hematologic remission in childhood acute lymphoblastic leukemia: report of a metatarsal relapse and review of the literature.

An 11-year-old boy with prior bone marrow and testicular relapses of his acute lymphoblastic leukemia (ALL) developed an isolated metatarsal bone relapse during complete hematologic remission 10 months after completion of chemotherapy. Although there was no radiographic or histologic evidence of additional occult leukemia, the polymerase chain reaction (PCR) technique detected a leukemic clone in both his bone marrow and metatarsal. A literature survey revealed only 10 reported cases of isolated bone relapse occurring during complete bone marrow remission in childhood ALL. Most of these patients had prior bone marrow or extramedullary relapses. The majority experienced subsequent relapses after their isolated bone recurrence. We report a case of isolated bone recurrence, review all previously reported cases, and suggest that PCR elucidation of clonal disease may provide a better understanding of these extremely rare extramedullary events.

Humans↗
PubMed2006

Relapse of T-cell all after stem cell transplant presenting as hypertrophic cardiomyopathy: the value of non-invasive diagnostic imaging in detecting cardiac leukemia.

We describe a 14-year-old female with acute lymphoblastic leukemia (ALL) with a mediastinal mass at diagnosis who developed hypertrophic cardiomyopathy (HC) after stem cell transplantation (SCT). During refractory relapse after SCT using bone marrow from her HLA-matched sibling, she underwent whole thorax irradiation because of pleural effusion and a recurrent mediastinal mass. After a second SCT using peripheral blood from the same donor, she developed HC suspected to be related to tacrolimus. However, isolated cardiac relapse was finally diagnosed by several non-invasive imaging techniques. Cardiac irradiation resolved her cardiac failure, though she eventually developed progressive and fatal hematological disease.

Adolescent↗
PubMed2007

The clinical value of follow-up examinations in childhood T-cell acute lymphoblastic leukemia and T-cell non-Hodgkin's lymphoma.

BACKGROUND: The aim of this study was to evaluate the value of follow-up investigations of T-cell acute lymphoblastic leukemia (T-ALL) and T-cell non-Hodgkin's lymphoma (T-NHL), including cerebrospinal fluid (CSF) examination, bone marrow (BM) aspiration, peripheral blood (PB) count, serum lactate dehydrogenase (LDH) and chest X-rays in patients with an initial mediastinal enlargement. PROCEDURE: We reviewed clinical records of all T-ALL patients from 1987 to 2002 and all T-NHL patients from 1977 to 2002, seen at a single institution. RESULTS: Of 48 T-ALL patients, 15 suffered from a relapse, 6 (40%) were asymptomatic at the time of relapse. T-ALL (13/30) with mediastinal enlargement at first diagnosis relapsed versus 2/16 of those without mediastinal enlargement. However, at relapse, only one patient had a mediastinal mass, which in addition was symptomatic. Of 39 T-NHL patients, 6 patients relapsed. Forty percent of relapsed T-ALL and 17% of relapsed T-NHL were asymptomatic. The seven asymptomatic relapses were detected by CSF (n = 4), BM (n = 2) or blood count (n = 1) examinations. All T-ALL and T-NHL patients with a mediastinal relapse were symptomatic. CONCLUSIONS: This study suggests that routine CSF examinations during treatment can detect relapses of T-ALL and T-NHL before onset of symptoms, which might be of clinical value. Relapses are rarely detected by BM or blood examinations and whether this translates in a clinical benefit is unlikely. Routine chest X-rays are not useful.

Adolescent↗
PubMed1981

Acute monocytic leukemias.

Normal monocytes and macrophages are characterized by peculiar ultrastructural and cytochemical features and, in addition, show characteristic membrane properties, a variety of special functional capacities, and important secretory activities. Almost all these cytological features can also be detected in leukemic monocytic cells, and it is quite conceivable that these peculiar features may influence or determine the clinical syndrome associated with the leukemic accumulation of monocytic cells. The morphological identification of monocytic leukemias is a very intriguing diagnostic problem and some controversies still exist concerning their cytological classification. For clinical as well as scientific purposes the diagnosis of monocytic leukemias should rely on the demonstration of specific monocytic features of the leukemic cells. Clinical findings frequently associated with acute monocytic leukemia include increased frequency of leukemic tissue infiltrations as well as increased tendency to hypokalemia and - especially in the "immature" variants - to disorders of hemostasis.

Cell Adhesion↗
PubMed1984

Human tissue distribution of 4'-(9-acridinylamino)-methanesulfon-m-anisidide (NSC 141549, AMSA).

Concentrations of AMSA were determined by HPLC in autopsy tissue samples from five patients who had received the drug antemortem. Relative organ concentrations of AMSA varied from patient to patient; however, concentrations were generally highest in gallbladder, liver, and kidney, while low levels were generally but not invariably found in lung, testicle, muscle, fat, spleen, bladder, pancreas, colon, prostate, and brain. One patient with ventricular fibrillation and seizures had high tissue AMSA concentrations in myocardium, but low concentrations in brain. Another patient with seizures during treatment had high brain concentrations of AMSA. Relative organ concentrations were similar to those found in mice, except that mice have high AMSA concentration in their spleens whereas our patients did not, even when the spleen was infiltrated with leukemic cells. High tissue concentrations of AMSA were still present 2 weeks after treatment. AMSA concentration was lower in a renal oncocytoma (1.1 micrograms/g) than in surrounding kidney (2.4 micrograms/g).

Adult↗
PubMed1988

Clinicopathological study of hematological disorders after Thorotrast administration in Japan.

Ten leukemia and four aplastic anemia cases were clinicopathologically studied in autopsies from patients who had been administered the contrast medium, Thorotrast, three to five decades previously. The short period from the appearance of hematological symptoms to death, the relatively low percentage of leukemic cells in the peripheral blood, the high frequency of erythroleukemia, i.e., 50% of leukemia patients, and a case of atypical megakaryocyte proliferation were revealed in leukemia patients. Leukemic cell infiltration in the spleen tended to become slight or minimal with the progress of fibrosis. As a result, the degree of spleen swelling was mild or lacking in leukemia patients who had been administered Thorotrast. On the other hand, cases such as hyperplastic or normoplastic bone marrow, an increase in immature granulocytic series or no decrease in the number of megakaryocytes were observed in aplastic anemia of Thorotrast-administered patients. It was thought that fibrosis in the bone marrow as well as in the spleen was induced by Thorotrast deposition. Thus, in hematological disorders of Thorotrast-administered patients, both leukemia and aplastic anemia cases were considered to be mainly of the atypical type, and it was speculated that the damage due to Thorotrast may affect the hemopoietic stem cell level and hemopoietic microenvironment.

Adult↗
PubMed1990

Syndrome of the posterior and anterior root in a late isolated CNS relapse of c-ALL. Case report.

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.

Adolescent↗
PubMed1994

Immunotoxin therapy of leptomeningeal neoplasia.

Malignant tumors of the central nervous system can result from metastatic dissemination of a variety of cancers. Percutaneous intracisternal injection of an anti-idiotype monoclonal antibody (M6) ricin immunotoxin was shown to be moderately effective in prolonging the survival of tumor bearing animals supporting the use of immunotoxins for the treatment of central nervous system neoplasia (Zovickian J and Youle R.J. J. Neurosurg 68: 767, 1988). This report describes a method that significantly improves the survival of immunotoxin treated Strain 2 guinea pigs in a syngeneic animal model of leptomeningeal neoplasia. Strain 2 guinea pigs, implanted with subarachnoid catheters, received three courses of treatment with an (M6)-intract ricin immunotoxin following intracisternal inoculation of L2C leukemia tumor cells. Animals were treated with three to four micrograms of immunotoxin in three divided doses. This was found to be less toxic and more effective than single bolus administration of immunotoxin. These results demonstrate that a permanent indwelling catheter in this animal model facilitates multiple dose delivery of immunotoxin therapy allowing the assessment of various treatment schedules and the achievement of enhanced therapeutic effect. Furthermore, these results support the continued evaluation of immunotoxins for the treatment of central nervous system neoplasia.

Animals↗
PubMed1995

Bilateral orbital granulocytic sarcoma (chloroma) preceding the blast phase of acute myelogenous leukemia: CT findings.

Granulocytic sarcoma (chloroma) is an uncommon malignant neoplasm associated with myelogenous leukemias. Its appearance may precede the clinical manifestations of the acute leukemic phase by months to years. We report the CT findings of a case of bilateral intraorbital granulocytic sarcoma which preceded the blast phase of acute myelogenous leukemia (AML) and led to its diagnosis. An awareness of granulocytic sarcoma and its CT appearance may expedite the diagnosis of AML or prompt close monitoring of those cases of granulocytic sarcoma antedating the appearance of AML.

Blast Crisis↗
PubMed2000

Enhanced migration of the acute promyelocytic leukemia cell line NB4 under in vitro conditions during short-term all-trans-retinoic acid treatment.

All-trans-retinoic acid (RA) is a potent differentiating agent that is very effective in the treatment of patients with acute promyelocytic leukemia (APL). Since clinical response can be accompanied by extramedullary manifestations, we have investigated the influence of RA on cell adhesion to and migration through reconstituted basement membranes (Matrigel) in the APL cell line NB4. No apparent cellular differentiation was observed during a 24-h incubation with 1 microM RA, as indicated by the nitroblue tetrazolium reduction test. However, exposure to RA significantly enhanced NB4 cell adhesion to Matrigel and consecutive migration through Matrigel barriers in a dose-dependent manner. Several integrin molecules potentially involved in this process, i.e., CD29, CD18, CD11a, CD11b and CD11c, were therefore studied by fluorescence-activated cell sorting analysis. The expression of the beta subunit of the beta2 integrins (CD18), but not that of beta1 integrins (CD29), was increased during 24-h RA treatment. Among the beta2 integrins, the expression of LFA-1 (CD11a) and of Mac-1 (CD11b), but not of p150,95 (CD11c), was induced by RA. When monoclonal antibodies that specifically block the interaction of these integrins with their ligands were used, we observed that CD29 is only involved in adhesion and CD11b only in migration, whereas CD11a participates in both processes. NB4 cells constitutively secreted the matrix metalloproteinases MMP-9 and MMP-2, which are known to promote cellular invasion processes by degradation of the extracellular matrix. RA treatment had no influence on the quantity of secreted MMP-9 or MMP-2 in these cells as determined by zymography. Addition of Batimastat (BB-94), a synthetic inhibitor of matrix metalloproteinases, blocked RA-induced cell migration without affecting cellular adhesion to Matrigel. These findings indicate that adhesion molecules as well as matrix metalloproteinases are involved in RA-stimulated migration of NB4 cells through Matrigel, possibly providing some explanation of tissue infiltration by leukemic cells as observed during treatment of APL patients with RA.

Antibodies, Monoclonal↗