[Neuroleukemia in the recurrence of acute leukemia in children].
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Acute Disease↗
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Results for “Leukemic Infiltration”
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Prevention and treatment of meningeal leukemia in children.
The prevention of meningeal leukemia has long been a keystone in its cure. The need was recognized when it became apparent in the 1950s and 1960s that meningeal relapse heralded hematologic relapse and a fatal course and that its incidence increased as systemic chemotherapy became more effective in controlling hematologic and visceral leukemia. Evasion of a biologic safety net, the blood-CSF barrier, is required to prevent meningeal leukemia. Three methods are used: meningeal radiotherapy, intrathecal administration of antileukemia drugs, and high-dosage intravenous antileukemia drugs. Recent and current clinical studies reflect a continuing dialogue about which methods are preferable and under what circumstances. For prevention of meningeal leukemia, extended intrathecal therapy and intensive systemic chemotherapy appear to be as effective as radiotherapy for most patients. For treatment of overt meningeal leukemia, meningeal radiotherapy may be necessary. However, its administration compromises subsequent systemic chemotherapy so that delay may be advisable to allow intensive systemic chemotherapy for control of concurrent hematologic and visceral leukemia, whether clinically evident or not. For patients with meningeal leukemia at diagnosis, cranial irradiation may be delayed or possibly omitted if evidence of disease is minimal and intrathecal and systemic chemotherapy are intensive. For those who develop meningeal leukemia while on therapy or after its completion, cranial or craniospinal irradiation is probably required as well as intensive intrathecal and systemic chemotherapy. Hopefully, current and future studies will dispel the uncertainties and better quantitate risks and benefits of alternative methods. Whatever method is used, careful attention to technical details is required to assure optimal efficacy at the least possible expense in immediate toxicity and late sequelae.
Child↗
[The morphoimmunological correlates in the leukemic degeneration of prolymphocytic lymphosarcoma].
Morphocytochemical and immunologic features of the bone marrow and peripheral blood lymphoid elements were studied in 40 patients with B-prolymphocytic lymphosarcoma in the stage of leukemic degeneration. Four types of pathologic lymphoid cells were distinguished: large prolymphocytes expressing pan-B CD19 and HLA-Dr antigens, medium-sized prolymphocytes with round nuclei, characterized by activation CD38 and CD45Ra antigens, prolymphocytes with split nuclei containing light and heavy immunoglobulin chains, and leukemic lymphocytes containing, besides pan-B antigens and immunoglobulins, antigens of the early hemopoietic (CD34) and early B-(CD10) precursors. The content of the RAS-positive substance in the prolymphocytes was inversely proportional to the parameters of activation antigens expression. Acid phosphatase activity correlated with the expression of CD22 and CD45Ra antigens.
Adult↗
Leukemia cutis.
Leukemia cutis is an uncommon manifestation of leukemia that is strongly associated with the presence of extramedullary disease at other sites. Patients usually present with leukemia cutis concomitantly with systemic leukemia or after leukemia has been diagnosed. Acute monocytic, myelomonocytic, and the T-cell leukemias show the highest incidence of leukemia cutis. The lesions show varied morphology and can be difficult to distinguish both clinically and histopathologically from nonspecific cutaneous lesions, which occur much more frequently. Immunohistochemistry is useful in making the distinction between them. The prognosis in leukemia cutis is generally poor; the best results have been achieved with a combination of systemic and local therapy.
Antigens, CD↗
Advances in understanding the mechanisms and management of acute myelogenous leukemia.
PURPOSE/OBJECTIVES: To review current knowledge about the causes, pathophysiology, treatment, and nursing care of patients with acute myelogenous leukemia (AML). DATA SOURCES: Articles, books, and proceedings of national meetings. DATA SYNTHESIS: AML, an an often fatal disease, is characterized by signs of anemia, thrombocytopenia, neutropenia, and leukemic cell infiltration throughout the body. Possible etiologies include genetic predisposition and exposure to radiation, chemicals, and viruses. Various types of chemotherapy and bone marrow transplantation are treatments of choice. Both result in significant side effects and complication rates. CONCLUSIONS: Throughout every stage, nursing care is of the utmost importance. Research continues to increase understanding of the disease process and the survival of patients. IMPLICATIONS FOR NURSING PRACTICE: Goals of care are directed at prevention of bleeding, infection, fluid and electrolyte imbalance, and chemotherapy-related side effects; assisting patients and families to cope with diagnoses, therapy, and prognoses; and helping the patient to achieve an acceptable quality of life regardless of the eventual outcome.
Acute Disease↗
Cytostatic effect of 9-(2-phosphonomethoxyethyl) adenine (PMEA). II. Lymphoblastic leukemia in Sprague-Dawley rats.
Two cases of spontaneous acute lymphoblastic leukemia in the inbred strain of Sprague-Dawley (Prague) rats have been observed. Since its reliable transplantability in syngeneic recipients was established, leukemic animals were used to test the cytostatic effect of PMEA. The treatment resulted in a significant prolongation of survival time of the treated animals. At the same time histological examination of PMEA-treated and untreated animals indicated that the drug effectively slows down the growth of lymphoma at the site of inoculation and inhibits the subsequent progression of tumor cells in the lung, liver, spleen and lymph nodes.
Adenine↗
Acute myeloid leukemia: ecchymoses as sole clinical symptom.
Acute myeloid leukemia is a hematologic malignancy accompanied by specific skin involvement in only about 10 percent of reported cases. We present a case of acute myeloid leukemia in which a hemorrhagic disorder of the skin was the first and only clinical symptom of the disease before the patient died from cerebral hemorrhage.
Acute Disease↗
Ocular metastatic disease.
Metastasis to the eye represents by far the most common form of intraocular and orbital cancer. This form of malignant disease may present with a variety of signs and symptoms including pain, vision loss, visual field defect, and proptosis. This varied clinical presentation is described, and available treatment modalities are discussed.
Eye Neoplasms↗
Malignant cutaneous tumors in children. Twenty years of experience at a large pediatric hospital.
The frequency of different malignant cutaneous tumors (MCTs), primary and metastatic, in children is not known. We reviewed all MCTs, primary and metastatic, seen during a 20-year period in a large general pediatric hospital. Fifty-three MCTs, 36 primary and 17 metastatic, were diagnosed in 36,207 pediatric dermatology patients. The incidence was 1.4 per 1000 patients. The relative frequency of occurrence of the different tumors was as follows: rhabdomyosarcoma, 25%; lymphomas, 19%; basal cell carcinoma, 13%; leukemia, 13%; neuroblastoma, 10%; malignant melanoma, 6%; squamous cell carcinoma, 6%; unclassified sarcomas, 4%; epithelioid schwannoma, 2%; ependymoma, 2%. The mean follow-up was 3 years; 48% died, 27% were lost to follow-up, and 25% are under control. We conclude that primary and metastatic MCTs in children are rare. Their types differ from MCTs in an older age population. MCTs in children are associated with a high mortality rate, often related to late recognition.
Basal Cell Carcinoma↗
Leukemic relapse presenting as acute unilateral hypopyon in acute lymphocytic leukemia.
A 16-year-old girl with acute lymphocytic leukemia in hematologic remission and no evidence of active central nervous system disease had a unilateral hypopyon as her sole site of relapse. She underwent diagnostic paracentesis and was treated with topical corticosteroids, chemotherapy, and radiotherapy to the central nervous system. Ocular involvement of the iris and anterior chamber as the site of primary disease or a relapse is a rare event. The anterior chamber serves as a sanctuary for cancer cells, and treatment protocols, including better anterior chamber prophylaxis, are warranted.
Adolescent↗
Early extramedullary relapse of acute myelogenous leukemia in bilateral breasts: a case report.
We report a case of a 19-year-old female with acute myelogenous leukemia successfully treated with daunorubicin and Ara-c. Eight months after complete remission, palpable breast masses developed bilaterally. Biopsy and fine needle aspiration of the right mass showed cluster of leukemic cells indicative of extramedullary leukemic relapse. One month after biopsy, the patient's bone marrow showed presence of 90% blast cells. Palpable breast mass may be an early sign of relapse of acute myelogenous leukemia.
Adult↗
Involvement of the complement system in the pathogenesis of pulmonary leukostasis in experimental myelocytic leukemia.
The role of the complement system in the pathogenesis of pulmonary leukostasis in myelocytic leukemia was studied in a rat model. Acute myelocytic leukemia was induced in six Brown-Norway rats, and complement levels were assayed during the course of the disease. Whole complement activity (CH50) and hemolytic activity of C1q, C3, and C4 decreased from day 16 after induction of the leukemia, when the rats developed pulmonary leukostasis. In addition, local complement activation was established in the lung vessels by immunofluorescence microscopy in advanced stages of pulmonary leukostasis. Finally, following systemic activation of the complement system by injection of cobra venom factor (CVF), leukemic rats (n = 6) died of pulmonary leukostasis 4.5 days earlier than did leukemic controls (n = 6). These findings suggest that, in acute myelocytic leukemia in Brown-Norway rats, pulmonary leukostasis is induced by activation of the complement system. This finding could lead to new modes of treatment for a life-threatening complication of leukemia.
Animals↗
Development of a lacZ marked WEHI-3B D+ murine leukemic cell line as an in-vivo model of acute non-lymphocytic leukemia.
Established leukemic cell lines have been useful models for studying the biology of leukemia. Analysis of the actions of differentiating agents on leukemic cell lines in vivo has been limited by an inability to unambiguously distinguish host hematopoietic elements from differentiated leukemic cells. In order to identify and quantify leukemic cells during in vivo studies, a derivative of the murine myelomonocytic leukemia cell line WEHI-3B D+, which stably expresses beta-galactosidase, was constructed utilizing retroviral vector gene transfer. This cell line, termed WEHI-3B D+/lacZ 2.8, demonstrated in vitro growth and differentiation properties similar to the parental cell line. WEHI-3B D+/lacZ 2.8 expressed high levels of beta-galactosidase following prolonged in vitro growth and following differentiation in suspension cultures and clonogenic assays. In vivo, WEHI-3B D+/lacZ 2.8 was leukemogenic and high level expression of beta-galactosidase was maintained. Quantification of tissue involvement with WEHI-3B D+/lacZ 2.8 leukemia was performed utilizing staining with the fluorogenic beta-galactosidase substrate fluorescein di-beta-galactoside and fluorescence-activated cell sorting analysis. In vivo differentiation efficiency following granulocyte colony-stimulating factor (G-CSF) administration was determined using a simultaneous nuclear and cytoplasmic staining procedure. Results indicate that treatment of mice inoculated with WEHI-3B D+/lacZ 2.8 cells with G-CSF administration causes detectable but limited differentiation.
Animals↗
Management of unusual presentations of acute leukemia.
Unusual patterns of presentation of acute leukemia are discussed, with an emphasis on the diagnostic and therapeutic challenges that they pose. Clinical syndromes reviewed include the leukostasis syndrome, disseminated intravascular coagulation, granulocytic sarcoma, central nervous system leukemia, leukemia cutis, Sweet's syndrome, pyoderma gangrenosum, and acute leukemia diagnosed during pregnancy. Each of these uncommon presentations of acute leukemia has a unique impact on patient management.
Abnormalities, Drug-Induced↗
[Two cases of acute leukemia with t(6;9) (p23;q34)].
Two cases of acute leukemia with a t (6;9) (p23;34) chromosome abnormality are reported. The first case was a 34-year-old female who was hospitalized in October 1989. A diagnosis of FAB-M1 was made. Chromosomal analysis of the bone marrow cells showed a 46, XX, t (6;9) (p23;q34). Complete remission was achieved after two courses of BHAC-DMP therapy. In September 1991, at the time of relapse, chromosomal analysis revealed two abnormal clones consisting of a 46, XX, t (6;9) (p23;q34), -12, -17, +der (12) t (12;17) (p11.2;q11.2) with a residual normal clone. She died in February 1992. The second case was a 42-year-old male who was hospitalized in January 1990. He was diagnosed as having RAEB. Chromosomal analysis of the bone marrow cells showed 46, XY, t (6;9) (p23;q34). Three months later, the disease progressed to acute leukemia accompanied by leg ulceration with leukemic cell infiltration. Small-dose ara-C therapy was given, but with no effect. After two subsequent courses of therapy with low-dose etoposide, complete remission was achieved. Four months later, relapse occurred, and the patient died of sepsis in February 1991. In the literature, 31 cases of myeloproliferative disorders with t (6;9) have been reported.
Acute Disease↗
Cutaneous granulocytic sarcoma at the exit site of Hickman indwelling venous catheter.
An unusual case of cutaneous granulocytic sarcoma (chloroma) developing at the exit site of a Hickman indwelling venous catheter in a patient with acute myelogenous leukemia (AML) is described. The possible role of the venous catheter in the development of this tumor at this unusual site is discussed.
Acute Disease↗
Relapse of acute myeloblastic leukaemia presenting as temporal bone chloroma with facial nerve paralysis.
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Adult↗
Granulocytic sarcoma in patients with chronic myeloid leukaemia.
Granulocytic sarcoma is an unusual variant of myeloid malignancy most commonly encountered in the course of chronic or acute myeloid leukaemia. Of 60 patients of chronic myeloid leukaemia studied over 21 months, we encountered 6 (10%) cases of granulocytic sarcoma. Four of these had granulocytic sarcoma on their first presentation. All those who were receiving hydroxyurea did not fare well but one who was put on DAT (daunorubicin, cyftosine arabinocide, 6 thioguanine)regimen went into remission with complete disappearance of lesions.
Adolescent↗