Course Of Acute Lymphoblastic Leukemia Research Articles

Treatment-related mortality in the course of acute lymphoblastic leukemia – case report

Treatment-related mortality in the course of acute lymphoblastic leukemia – case report

Myelopathy associated with acute leukemia. Multidisciplinary view on the problem

Leukemia-associated myelitis is a rare but underestimated complication. It has a different etiology associated with both, the main disease and its treatment methods. It requires differential diagnosis with funicular myelosis, polyradiculoneuropathy, tumor and hemorrhagic formation, stroke, dysmetabolic manifestations, as well as with the consequences of treatment of the underlying disease using radiation, cytostatic, targeted therapy.It should also be differentiated from paraneoplastic myelopathy and progression of the underlying disease. However,with the help of neuroimaging methods, it can be detected more recently than a detailed clinical picture appears. A case report of myelopathy in a 31 year old patient with acute lymphoblastic leukemia is presented. Treatment of the underlying disease was carried out with the use of chemotherapy, radiation therapy, allogeneic hematopoietic stem cell transplantation and targeted therapy. The nature of the disease,i.e. recurrent course of acute lymphoblastic leukemia, the variety of treatment methods, and the absence of focal changes in neuroimaging in the zone that determines clinical manifestations, made it necessary to consider a wide range of possible etiological factors for the development of myelopathy. Myelopathy was confirmed by MRI 2.5 months after the debut of neurological symptoms, which corresponds to modern concepts and time criteria for visualization in neurooncology. The article presents the criteria for diagnosing myelopathy, a complication of acute lymphoblastic leukemia. It should also be differentiated from However, with the help of neuroimaging methods, it can be detected more recently than a detailed clinical picture appears.

PROGNOSIS OF THE COURSE OF CHORNOBYL-ORIGINATED ACUTE LYMPHOBLASTIC LEUKEMIA IN CHILDREN IN UKRAINE DEPENDING ON THE REASON OF STANDARD CHEMOTHERAPY INTERRUPTION.

Estimation of the bone marrow haemopoietic status depending on the reasons and duration of breaks in a standard chemotherapy (BFM-ALL protocol) to predict the course of acute lymphoblastic leukemia (ALL) in chil- dren exposed to low doses of ionizing radiation after the Chornobyl accident. The ALL patients (n = 34) were examined within 5 stages of a program chemotherapy. The clinical symptoms, hemogram and myelogram data were analyzed. The radiation dose on bone marrow, initial leuko- cyte count, variants and prognosis of ALL course were accounted. Days of the stopped chemotherapy, type and fre- quency of complications (septic processes, febrile neutropenia, toxic hepatitis, granulocytopenia degree), and the prognosis of disease course (child living status, i.e. alive or died) were estimated. There were abnormal differentiation processes and high percentage of lymphoblasts (86.2 ± 3.3) % in bone marrow in the 1st acute period. Hematological remission was established in all patients on the 33rd day of chemothe- rapy. In a half of cases the haematopoietic recovery occurred by a granulocyte-monocyte type. One third of patients presenting an erythroid type of haemopoiesis died later. The inverse correlation was found between the number of myelocaryocytes and disease prognosis (rs = -0.49). Breaks in chemotherapy for various reasons were recorded. The number of patients with granulocytopenia was greater at the phase 1 and 2 of protocol I and protocol M application, coinciding with a higher incidence of complications. An inverse correlations between the prediction of ALL course and sum of days of breaks between the protocol M and phase 1 of protocol II (rs = -0.56), as well as the duration of the phase 2 of protocol II (rs = -0.62) were found. The radiation dose on bone marrow was (5.37 ± 1.23) mSv. No relationship was found between the radiation doses, ALL variants and disease course. Prognosis of ALL course in children depends on the type of haemopoietic recovery and reasons of breaks in a standard chemotherapy. Interaction between the haemopoiesis functioning and microenvironment and that of their regulation are the key mechanisms of above-mentioned abnormalities, which is the basis for further research.

Successful resolution of Epstein–Barr virus-associated hemophagocytic lymphohistiocytosis during the treatment course of acute lymphoblastic leukemia

Successful resolution of Epstein–Barr virus-associated hemophagocytic lymphohistiocytosis during the treatment course of acute lymphoblastic leukemia

Pyomyositis in the course of acute lymphoblastic leukemia

Pyomyositis is a term used to asses pyogenic infection of the skeletal muscle and develops as the result of bacteriemia and occurs most commonly in patients with various immunosuppressive diseases. Pyomyositis should be considered in the differential diagnosis in patients complaining of intensive muscle pain and fever. The usual causative organism is Staphylococcus aureus. We present a 3-year-old boy with acute lymphoblastic leukemia (ALL) and pyomyositis caused by Pseudomonas aeruginosa diagnosed in the course of induction therapy. The diagnosis of pyomyositis in the crural muscles of both legs was given based on imaging examinations: ultrasonography and magnetic resonance.

Fulminant and Fatal Course of Acute Lymphoblastic Leukemia Due to Lactic Acidosis and Suspected Abdominal Compartment Syndrome

Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy and its prognosis has considerably improved over the past 2 decades due to new therapeutic approaches. In some cases, however, it can develop very rapidly and cause possibly fatal complications. We report on the case of an 11-year-old boy with ALL, who rapidly developed severe lactic acidosis and abdominal compartment syndrome. He died of multiorgan failure only 5 days after diagnosis of ALL had been established. Autopsy revealed systemic leukemic infiltrations. We suppose that the mass of tumor cells induced a cascade of metabolic and endocrine reactions, which not only triggered the rapid progression of the disease but were also accountable for the lack of response to treatment. The pathophysiology of abdominal compartment syndrome as a rare and in our case ultimately fatal complication of ALL is described.

The mystery of electroencephalography in acute lymphoblastic leukemia

The aim of the study was to evaluate changes in electroencephalogram (EEG) recordings during the course of acute lymphoblastic leukemia (ALL) in children. The study group consisted of 48 children with ALL who underwent a total of 72 EEGs at various stages of the disease. The medical files were reviewed for pertinent clinical data, and the EEGs were evaluated for changes in brain activity. Abnormal background activity was noted in 52.2% of the EEGs done at 1–10 days of therapy, in 43.5% of those done at 10–60 days, and only 4.3% of those done at later stages ( p = 0.037). These findings, together with earlier reports, suggest that early-stage ALL, even before treatment, may be associated with excessive slow EEG activity, which improves over time. The EEG changes, by themselves, are not an indication of central nervous system leukemia or a predictor of later seizures or other central nervous system involvement.

小児急性リンパ性白血病治療中に合併するLeukoencephalopathy（白質脳症）について

小児急性リンパ性白血病治療中に合併するLeukoencephalopathy（白質脳症）について

Skeletal status in survivors of acute lymphoblastic leukemia assessed by quantitative ultrasound at the hand phalanges: A longitudinal study

The skeletal growth in a course of acute lymphoblastic leukemia (ALL) may be affected, and the aim of the longitudinal study was to assess the skeletal status in survivors of (ALL). The studied population consisted of 38 subjects (17 female and 21 male) measured at the age of 13.9 ± 3.8 years (5.7 ± 2.9 years after completion of the therapy, 11.0 ± 14.4 years after diagnosis) and 2 years earlier; compared with 1402 controls (628 female and 774 male). Patients and controls did not differ significantly in regard to age, height or weight. Skeletal status was assessed by quantitative ultrasound (US) measurements at the hand phalanges using the DBM Sonic 1200, which measures amplitude-dependent speed-of-sound, Ad-SoS (m/s). rms CV% was 0.43%. Mean baseline Ad-SoS value in patients was 1990 ± 76 m/s and, at second measurement, 2045 ± 86 m/s ( p < 0.000001). In 31 patients, Ad-SoS increased and, in one patient, decreased more than the value of the least significant change. In controls, mean Ad-SoS values were 1973 ± 64 m/s (baseline) and 2016 ± 86 m/s (follow-up) and did not differ significantly vs. baseline values in patients. At second measurement, Ad-SoS in controls was significantly lower than in patients ( p < 0.05). In five patients with low baseline Ad-SoS values, bone mineral density (BMD) at the spine using DPX-L was estimated; baseline mean BMD was 0.95 ± 0.11 g/cm 2, Z-score was 1.25 ± 0.97 and, at second measurement, 1.16 ± 0.07 g/cm 2, Z-score was 0.23 ± 0.43. A significant increase in BMD ( p < 0.01) and Z-score ( p < 0.05) was noted. In patients, Ad-SoS correlated significantly with age, period after completion of the therapy, body size and Tanner stages (r ranged from 0.43 to 0.83, p ranged from 0.0001 to 0.05). It can be concluded that skeletal status assessed by quantitative US at the hand phalanges in survivors of ALL improved significantly over the period of observation. (E-mail: osteolesna@poczta.onet.pl)

Significance and limits of cerebrospinal fluid beta-2-microglobulin measurement in course of acute lymphoblastic leukemia.

Cerebrospinal fluid beta-2-microglobulin (CSF-beta 2m) was measured longitudinally in 48 patients affected by acute lymphoblastic leukemia (ALL). Thirteen developed a central nervous system (CNS) involvement during the course of the disease; although moderately higher mean CSF-beta 2m levels were found in these subjects, no significant statistical differences were observed in comparison with patients without this complication and compared with the control group. No correlations were found between beta 2m and other biochemical parameters in CSF. Furthermore, CSF-beta 2m levels appeared to be influenced by previous combined chemoradiotherapeutic treatment for CNS prophylaxis, presence of meningeal non-neoplastic infiltrates, patients' ages, amount of CSF blasts, and their immunological phenotype. In particular, only clearly B-committed leukemic cells, when tested, showed a strong surface expression of beta 2m, as demonstrated by immunocytochemical detection of this protein on cell membrane. However, in specific cases, CSF beta 2m measurement and CSF/serum beta 2m ratio were helpful in diagnosing and monitoring isolated CNS disease. Such findings suggest that CSF-beta 2m assay may be a useful tool in the management of CNS involvement in the course of ALL in only selected patients, as several factors can modify the outcome.

Intestinal Perforation during Remission Course of Acute Lymphoblastic Leukemia

Intestinal Perforation during Remission Course of Acute Lymphoblastic Leukemia

Serum selenium in children with acute lymphoblastic leukemia: Preliminary results

Serum selenium concentrations were analysed in 24 children with acute lymphoblastic leukemia and in 152 healthy schoolchildren. Selenium was determined by the energy dispersive X-ray fluorescence technique. Lower median selenium levels were found in children with leukemia, who were on maintenance therapy and who later relapsed, than in controls (p < 0.02) and in children who remained in remission and could have treatment discontinued (p < 0.01). Median observation time for children remaining in continuous complete remission (CCR) was 66 months. There was no significant correlation between low or high serum selenium concentrations on the one hand and either age, sex, weight and height, white blood cell counts (WBC), blood platelets, S-ASAT, S-ALAT, serum protein or serum albumin on the other. Further studies are needed to evaluate the role of selenium for the course of acute lymphoblastic leukemia in children.