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PubMed1990

Substance immunologically cross-reactive with insulin from murine myeloid leukemia: purification and characterization.

A substance immunologically cross-reactive with insulin (SICRI) appears in murine myeloid leukemia. Progression of disease is paralleled by the increase of SICRI levels in the serum; this increase of SICRI levels did not correlate with a decreased concentration of circulating glucose. SICRI was isolated and purified from spleen infiltrated with leukemic cells. Monospecific antiinsulin immunoglobulin G was used for immunoaffinity chromatography to isolate SICRI from tumor tissue. The purified substance yielded a single band with a molecular mass of about 150 kDa in polyacrylamide gel electrophoresis under denaturating and non-denaturating conditions. Purified SICRI enhanced growth of myeloid leukemia cells in soft agar. Biochemical and biological data together with our previous results obtained in other experimental tumors provide evidence that SICRI and insulin are two distinct biologically active agents. SICRI plays a role in murine myeloid leukemia as an autocrine growth promoting factor.

Animals↗
PubMed2004

T(11;18)-bearing pulmonary mucosa-associated lymphoid tissue lymphoma responding to cladribine.

Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade B-cell lymphoma and is usually slow to disseminate. The t(11;18)(q21;q21) translocation has been identified in a subset of MALT lymphoma cases, and AP12 and MLT1/MALT1 genes have been implicated in this translocation. However, the clinicopathologic features of t(11;18)-bearing MALT lymphoma have not been fully elucidated, and the optimal therapy for patients with disseminating disease is unknown. We report an outstanding case of MALT lymphoma that showed massive pulmonary infiltration and leukemic transformation during a prolonged course of more than 16 years. Reverse transcriptase-polymerase chain reaction and dual-color fluorescence in situ hybridization analyses confirmed the existence of the AP12/MLT1 fusion gene in the lymphoma cells. Peripheral blood lymphoma cells disappeared after glucocorticoid therapy. Although the pulmonary lymphoma was slowly progressive and caused severe hypoxemia despite the continuation of glucocorticoid therapy, treatment with cladribine induced a marked reduction of pulmonary lymphomatous lesions and an improvement of the hypoxemia. These findings show the unique clinical features of this particular indolent B-cell lymphoma with t(11;18) translocation and suggest the potential therapeutic usefulness of glucocorticoid and cladribine.

Adult↗
PubMed2004

Granulocytic sarcoma presenting with malignant anasarca in a patient with secondary acute myeloid leukemia.

Granulocytic sarcomas (GS) are rare extramedullary tumor masses composed of immature cells derived from the hematopoietic myeloid series. GS occur in 3% to 7% of cases of acute myeloid leukemia (AML) and can present before, during, or even after the diagnosis of AML. GS can involve different organs, individually or simultaneously, including the skin, lymph nodes, bone, breast, central nervous system, and lung among others. GS involving peritoneal and pleural fluids is a rare presentation. We present an unusual case of a patient with myelodysplastic syndrome whose disease progressed into a secondary AML and developed GS in the ascitic and pleural effusions as the predominant manifestation of disease progression.

Aged↗
PubMed1988

Primary gingival enlargement as a diagnostic indicator in acute myelomonocytic leukemia. A case report.

A 25-YEAR-OLD CHINESE FEMALE, five months pregnant, came to our dental clinic with a chief complaint of slight gingival inflammation. A diagnosis of pregnancy gingivitis was made. One week later, there was a sudden onset of extremely generalized gingival enlargement and very high WBC count (144,000/cmm) was noted. Physical, laboratory, and microscopic examination led to the diagnosis of acute myelomonocytic leukemia. The observations of good oral hygiene and clinical course suggested that leukemic cell infiltration was the major cause of sudden onset of gingival enlargement. This article emphasizes the importance of primary gingival enlargement in the initial diagnosis of leukemia.

Adult↗
PubMed2003

Severe alveolar bone loss and gingival hyperplasia as initial manifestation of Burkitt cell type acute lymphoblastic leukemia.

BACKGROUND: The purpose of this case report is to present severe alveolar bone destruction and gingival enlargement as initial manifestation of Burkitt cell type acute lymphoblastic leukemia (ALL-L3) in a 14-year-old boy. METHODS: The patient was referred to the periodontology department with a 4-week history of gingival enlargement and loosening of teeth. The clinical examination revealed gingival enlargement and expansion of alveolar mucosa particularly in molar regions of both jaws. Almost all teeth had deep periodontal pockets and severe mobility. While the radiographs showed severe alveolar bone loss which extended to apical thirds of many teeth, the microbiologic analysis revealed that the patient did not harbor major periodontopathogenic bacteria species. The results of blood tests and bone marrow aspiration were compatible with ALL-L3. RESULTS: Remission-induction treatment with BFM-90 ALL chemotherapy protocol was started; however, the patient died 4 weeks after the diagnosis due to neutropenic sepsis. CONCLUSIONS: Although no biopsy was performed, it is possible that the severe periodontal destruction and gingival enlargement in this case may have been due to the infiltration of leukemic cells in gingiva, periodontal ligament, and alveolar bone. The similarities of these findings with numb chin syndrome (NCS) and Burkitt's lymphoma (BL) are discussed in this report.

Adolescent↗
PubMed2001

Estrogen therapy in a male patient with chronic hepatitis C and irradiation-induced testicular dysfunction.

We report an 18-year-old male patient who developed chronic hepatitis C after blood transfusion and had testicular dysfunction after irradiation for a testicular relapse of childhood acute lymphocytic leukemia after cessation of maintenance therapy, and the initiation of testosterone replacement therapy at puberty. Concomitant administration of estradiol resulted in a reduction in serum alanine aminotransferase and ferritin levels and hepatic iron concentration and staining after 2 years of estrogen therapy, although interferon therapy was withdrawn because of adverse effects. This observation suggests that endogenous estradiol may play a beneficial role in male patients with chronic hepatitis C.

Adolescent↗
PubMed1985

Lactic acidosis and hypoglycemia associated with acute leukemia.

A 42-year-old man was admitted because of episodic attack of general malaise. He was lethargic and had a severe lactic acidosis and hypoglycemia. Blood chemistry and endocrinological data were normal. Glucose administration led to an improvement in the hypoglycemia but not the lactic acidosis. At autopsy, there was a massive infiltration of leukemic cells in both kidneys and in liver. Phosphoenolpyruvate carboxykinase, pyruvate carboxylase and glucose-6-phosphatase activities in patient's liver were much the same as in the control liver, but fructose-1, 6-diphosphatase activity was slightly reduced. Since circulatory failure was absent, type B lactic acidosis has to be considered. Since hypoglycemia was associated with acidosis, the severe lactic acidosis in our patient may have been due to an overproduction of lactic acid as well as to an impaired hepatic gluconeogenesis in the presence of leukemic cells.

Acidosis↗
PubMed1986

Effects of methotrexate on rabbit testes. Part 1: Morphological changes.

Methotrexate (MTX) has the potential of eradicating small infiltrations of leukemic cells in the gonads. We examined the morphological changes in rabbit testes after a single dose (57.5 mg/kgBW) or repeated low doses (6 mg/kgBW once a week for 14 weeks) of MTX IV. Fertility rate and spermatogenic activity were evaluated using the tubular fertility index (TFI). Testicular MTX concentrations (measured by RIA) were in the same range in both groups. Only after repeated MTX application were reduction of TFI and signs of germinal cell line degeneration found. When given repetitively, MTX therapy may modify the fertility and tubular morphology. Long-term follow-up will show how these changes affect future fertility.

Animals↗
PubMedDate not supplied

Primary ocular recurrence of leukemia following bone marrow transplant.

A patient with acute lymphoblastic leukemia (ALL) who had undergone an allogeneic bone marrow transplant that included high-dose chemotherapy and total body radiation without eye shielding, sustained an isolated relapse of her disease in the iris. A review of ocular leukemic disease is discussed.

Asparaginase↗
PubMedDate not supplied

Changes in lactate dehydrogenase isoenzymes associated with relapse of childhood acute lymphocytic leukemia.

Twenty-eight children with high-risk acute lymphocytic leukemia underwent monthly serum lactate dehydrogenase (LDH) and LDH isoenzyme fraction determinations to examine whether LDH isoenzyme fractions change with an increase in the body burden of tumor cells. The 9 patients who relapsed and 5 patients who presented with leukemia during the study period had a slightly lower mean LDH-1 isoenzyme fraction. When the period from 3 months before to 3 months after relapse was examined, significant increases in the LDH-3 isoenzyme fraction and decreases in the LDH-1 and LDH-2 isoenzyme fractions were seen at the time of relapse. These results were highly significant when patients with non-T-cell and T-cell leukemia were combined and when bone marrow and central nervous system relapse was included. The changes at relapse appeared to revert with intensification of chemotherapy. The changes at relapse were not different in magnitude from random variation occurring in patients who remained in remission throughout the study. Although changes in LDH isoenzymes appeared to occur at the time of relapse compared with the periods immediately before and after relapse, these changes were not specific for relapse. LDH isoenzymes do not appear to be useful in predicting relapse in children with leukemia.

Adolescent↗
PubMedDate not supplied

Myelotoxicity, pharmacokinetics, and relapse rate with methotrexate/6-mercaptopurine maintenance therapy of childhood acute lymphoblastic leukemia.

White blood cell and absolute neutrophil counts (WBC, ANC), aminotransferase (AT) levels, methotrexate (MTX) and 6-mercaptopurine (6MP) doses, metabolites in erythrocytes (E-MTX and E-6TGN), and the prognostic significance of these parameters were studied in 58 children receiving MTX/6MP maintenance therapy for acute lymphoblastic leukemia diagnosed from July 1986 to December 1991. At the end of follow-up July 1995, 13 patients had relapsed (pEFS = 0.77). Weighted means of AT, WBC, and ANC during and after maintenance therapy (mAT, mWBCON, mWBCOFF, mANCON, mANCOFF), E-MTX (mE-MTX), and E-6TGN (mE-6TGN) were calculated, as well as the product of mE-MTX and mE-6TGN (mE-MTX*6TGN), as MTX and 6MP probably act synergistically. Beyond higher MTX and 6MP doses to patients with high mWBCON, neither mWBCON, (median 3.5 x 10(9)/L), mANCON, nor mAT was correlated with the dose of MTX and 6MP, mE-MTX, mE-6TGN, or risk of relapse. Patients with mE-MTX*6TGN above or below 828 (nmol/mmol Hb)2 (median value) had pEFS values of 0.84 and 0.70, respectively (P = .16). All 5 patients who relapsed during therapy had mE-MTX*6TGN < 828 (nmol/mmol Hb)2 (P = .03). mWBCOFF and the degree of myelosuppression (= mWBCSHIFT = mWBCOFF - mWBCON; median: 2.5 x 10(9)/L) were related to age (rs = -0.50, P = .001 and rs = -0.40, P = .006, respectively). All eight relapses off therapy occurred in patients with mWBCSHIFT < 2.5 x 10(9)/L (P = .02). WBC levels during MTX/6MP therapy may underestimate the degree of MTX/6MP treatment intensity, especially in order children. Pharmacokinetic monitoring could be useful for optimizing MTX/6MP maintenance therapy.

Administration, Oral↗
PubMed2000

Disease features in acute myeloid leukemia with t(8;21)(q22;q22). Influence of age, secondary karyotype abnormalities, CD19 status, and extramedullary leukemia on survival.

Over a period of 14 years, 50 patients (12 children and 38 adults) of whom 46 had acute myeloid leukemia (AML) and 4 had myelodysplastic syndrome characterized by the t(8;21)(q22;q22) translocation were referred to the Royal Marsden Hospital. The clinicopathological features of these cases were analyzed to determine the influence of age, secondary karyotype abnormalities, and expression of the lymphoid marker CD19 on event free survival, and presence of extramedullary leukemia on overall survival. They were treated with a variety of chemotherapy protocols and some had bone marrow transplantation. There appeared to be no difference in survival between children (age <17 years) and adults (age >16 years). Out of the 50 cases, 16 (32%) had the (8;21) translocation alone, 17 (34%) had additional loss of a sex chromosome and the remaining 17 (34%) had other karyotype abnormalities of which deletion or translocation of the long arms of a #9 was most common (observed in 8 of the 17 patients). The karyotype groups had a significant impact on survival, the group with loss of a sex chromosome having a poorer outcome and the group with abnormalities of chromosome 9 having a better outcome. CD19 positivity was seen in 21 of the 33 cases (63%) in whom it was measured compared to 11% observed in controls with AML without a t(8;21). CD19 status did not exert any influence on event free survival. Extramedullary leukemia (EML) occurred in 5 of the 50 cases (10%). In one patient it was observed at diagnosis but in the others it presented concurrent with bone marrow relapse. The overall survival of patients with EML was worse than that of the other patients but did not achieve statistical significance and was probably adversely affected by other factors.

Acute Disease↗
PubMed2000

Vasculitis and leukemia.

Vasculitis may accompany neoplasias and be of paraneoplastic type or associated with drugs used in patient treatment. We evaluated skin biopsies of twenty-eight cases with vasculitis accompanying leukemias reviewed and clinical outcome was evaluated. Eleven of the 28 cases had paraneoplastic vasculitis and 17 had vasculitis associated with various drugs including chemotherapy, cytokines and antibacterial agents. Paraneoplastic vasculitis was seen in 3 cases with chronic myelocytic leukemia in blastic phase, 5 patients with acute myeloblastic leukemia, and 3 with myelodysplastic syndrome. Drugs responsible for the 17 cases of vasculitis included hydroxyurea, vincristine, cytosine-arabinoside, methotrexate, all-trans retinoic acid, granulocyte-colony stimulating factor, interferon and antibiotics. Paraneoplastic vasculitis is not rare in leukemias and may be a manifestation of the blastic phase of chronic myeloid leukemia. Furthermore paraneoplastic vasculitis can be fatal in myelodysplastic syndromes and may be present clinically before the specific diagnosis is made. Drugs used in routine therapy may be the cause of the vasculitis, thus skin biopsy should be performed in all cutaneous lesions in patients with hemopoietic neoplasias.

Adolescent↗