Diagnosis Of Acute Myelogenous Leukemia Research Articles

Acute Leukemia Following Cytotoxic Chemotherapy

To the Editor.— Recent attention has been directed to acute leukemia in patients treated with cytotoxic agents (219:75, 1972). We recently have had the opportunity to see a 65-year-old white woman who had unexplained anemia. The patient had had a mastectomy 18 months previously for carcinoma of the breast. She had received thiotepa as adjunctive therapy on a weekly basis since the original diagnosis. When seen by us, the patient had thrombocytopenia, anemia, and leukopenia. There was no evidence of recurrent breast carcinoma. The bone marrow was found to be dysplastic with megaloblastic changes. The patient was treated with both cyanocobalamin and folic acid despite normal Schilling test. Repeated bone marrow examination showed no change. There was no evidence on bone marrow biopsy of metastatic disease. Slides were reviewed by Dr. Richard Gams who concurred with our diagnosis of acute myelogenous leukemia. The patient was treated with the COAP program

Prolonged nephrogram due to hyperuricaemia.

Renal insufficiency due to hyperuricaemia (uric acid nephropathy) has been observed as a complication of leukaemia and lymphoma (Rieselbach, Bentzel, Cotclave, Frei and Freireich, 1964; Barry, Hunter, Davis and Crosby, 1967; Gold and Fritz, 1957; Greenbaum and Stone, 1959). It is caused by an increase in nucleoprotein catabolism and may occur spontaneously or be precipitated or exacerbated by chemotherapeutic agents and radiation therapy. It is an important cause of renal failure usually manifesting with oliguria or anuria. In this report hyperuricaemia in a patient with leukaemia was associated with abnormal nephrograms. D.M., a 12-year-old white female with acute myelogenous leukaemia, was admitted to the Children's Hospital Medical Center following several days of vomiting and abdominal pain. She had experienced several episodes of blood-stained urine during this time. The diagnosis of acute myelogenous leukaemia had been established two years prior to admission; several remissions had been achieved bu...

Intravascular coagulation in promyelocytic leukemia: a case study including ultrastructure.

A 15-year-old boy, admitted with a two months’ history of chest pain, cough, pallor, and progressive loss of energy, was found to have a right pleural effusion and pancytopenia; a diagnosis of acute myelogenous leukemia was made on bone marrow and peripheral blood examination. Blood transfusions, chemotherapy, and aspiration of pleural fluid effected a temporary clinical improvement, but the hematologic status continued to deteriorate. The temperature was elevated to 101 F. Cultures of blood, urine, and pleural effusion were negative. Twelve hours before the patient’s death the temperature rose to 103 F., and he had severe chest pains. Later, he became delirious, and had shallow grunting respirations and tachycardia. He died on the eleventh hospital day. At autopsy, the leukemic cells, identified as promyelocytes, were found infiltrating many organs. There were coagulase-positive staphylococcal septicemia, pneumonia, and pleuritis; hemorrhages into several tissues; and disseminated intracapillary or sinusoidal thrombosis in the lungs, liver, adrenal glands, and kidneys. Fibrin was a prominent component of these thrombi. The possible mechanisms of consumptive coagulopathy in acute promyelocytic leukemia are discussed.

Cytogenetic Studies in Acute Myelocytic Leukemia with Special Emphasis on the Occurrence of Ph1 Chromosome

Abstract Cytogenetic studies were carried out on 103 unselected patients with acute myelogenous leukemia (AML) at the Clinical Center of the National Institutes of Health. Seventy-three patients (70.9%) had a normal karyotype and 30 patients (29.1%) were aneuploid. No unique chromosomal abnormalities were found in patients with aneuploidy; however, there was a significantly higher incidence of G group involvement. Four cases had a history of radiation exposure; three of these four patients had a normal karyotype and one had one Ph1 chromosome in her bone marrow cells. Another patient with no history of radiation also had one Ph1 chromosome in his marrow cells. Reclassification of AML patients with Ph1 chromosomes as a rare entity of blast crisis in chronic myelogenous leukemia (CML) rather than as AML’s is proposed. Two patients exhibited the 45 chromosome syndrome before the diagnosis of AML was made. The normal and aneuploid groups had about the same median survival time and same median date from diagnosis to chromosome study; however, none of the patients in the aneuploid group lived longer than 26 months after the date of diagnosis, while seven patients (nearly 10%) in the normal group did so, one living over 112 months.

CHYLOTHORAX IN ACUTE LEUKEMIA

To the Editor .—Chylothorax was associated with hyperlipidemia in a 13-year-old girl in acute leukemic blastic crisis. Although obstructive chylothorax in adults with malignancies 1-3 has been previously noted, no similar cases have been associated with leukemia. The clinical observations and implications form the basis of this case report. Report of a Case The diagnosis of acute myelogenous leukemia in a 13-year-old girl was made on the typical basis of Auer's rod positive peripheral blood and bone marrow myeloblasts. Therapy consisted of mercaptopurine, methotrexate, vincristine sulfate, vinblastine sulfate (Velban), cytarabine, daunomycin, and repeated blood transfusions. The medication during the last six weeks was mercaptopurine (2.5 mg/kg) and prednisone (2.0 mg/kg). The patient never had a prolonged remission from any of these medications during the nine months of the leukemic process. During the last two months her weight was stationary. Multiple draining cutaneous abscesses of the lower extremities, respiratory distress,

Chloroma. Report of a patient with unusual rib lesions.

Chloroma is a manifestation of myelogenous leukemia in which leukemic tumors are colored green. The original description by King (10) in 1853 led to the belief that chloroma represented a separate disease entity. In 1937, however, Kandel (9) reviewed 58 cases reported in the literature and found that the chloroma without exception had been associated with myelogenous leukemia. The green color is attributed to reduced breakdown products of hemoglobin (8). In 1966 Filip and Bednář (3) showed in a series of 24 patients marked erythrophagocytosis by tumor cells. Chloroma occurs mainly in children, with predilection for the long bones, calvarium, and periorbital tissues. Roentgenographic descriptions are few, but periosteal elevation was prominent in the patients reported (1, 12). In the original roentgenographic description Gould and LeWald (5) noted underlying new bone at right angles to the shaft. No reports include roentgenographic reproductions of rib chloromas, although isolated rib lesions have been described (11). The present case report is prompted by an unusual roentgenographic appearance resembling the rachitic rosary, with symmetric involvement of the ribs anteriorly by multiple chloromas. Case Report A 10-month-old Caucasian female was admitted with the diagnosis of acute myelogenous leukemia. The child was normal at birth and well until the age of eight months when mild pallor appeared. Three weeks before admission she became anorectic and febrile with rapid respirations. The white blood cell count was 288,000, and many myelocytic blast forms were present. Hemoglobin was 6.4 g per 100 ml. Examination of bone marrow showed diffusely infiltrating acute promyelocytic cells. Treatment with 6-mercaptopurine had been instituted at another hospital. The patient did not improve, and she was transferred to the University of California Medical Center at San Francisco for further therapy. There was no family history of hematologic disease. A maternal grandmother had died of carcinoma of the uterus. Examination revealed an acutely ill female infant in severe respiratory distress. The conjunctivae were pale and the eyes were moderately proptotic. Shotty anterior and posterior cervical lymph nodes were palpable. Intercostal retractions and occasional rhonchi were noted in the chest; no rib masses could be palpated. The liver and spleen were moderately enlarged. The skin contained numerous ecchymoses. Laboratory Data: White blood cell count was 145,000; platelets, 1,000, hematocrit, 21 mm. Aspiration of bone marrow five days after onset of therapy revealed a pronounced hypocellularity with immature blast cells and erythrophagocytosis. Roentgenograms of the chest showed bilateral bulbous expansion of the anterior ends of the second through seventh ribs with periosteal elevation (Fig. 1). Patchy infiltrates were scattered throughout the lungs. Transverse radiolucent bands were seen in the proximal humeral metaphyses.