Acute Leukemia. Rakesh Biswas MD, Professor, Department of Medicine, People's College of Medical Sciences, Bhanpur, Bhopal, India. Leukaemia. A 16 year old girl Extreme pallor gum bleeds, Purpura,With Lymphadenopathy and Hepatosplenomegaly. Possible causes: Investigations and treatment.
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MD, Professor, Department of Medicine, People's College of Medical Sciences, Bhanpur, Bhopal, India
Group of malignant disorders of the hematopoietic tissues characteristically associated with increased numbers of white cells in the bone marrow and / or peripheral blood
2. Chronic :
After the oncologist performed a bone marrow aspiration to confirm the diagnosis of leukemia, we learned specifically what type it was and the count. "D had acute lymphoblastic leukemia, early pre-B cell.
Ph –ve, BCR-abl +ve
Ph –ve, BCR-abl -ve
Ph: Philadelphia chromosome
BCR: Breakpoint cluster region; abl : Abelson oncogene
Unknown / De-novo !! In majority
General : Onset is abrupt & stormy
(usually present within 3 months)
MPO (right) & Sudan black (left) showing intense localised positivity in blasts
Cytogenetics: Chromosomal abnormalities
I. Supportive care :
The next thing that occurred was a procedure called leukopheresis.This procedure lasted 4 hours and cut D’s white blood cell (WBC) count in half--to about 250,000.
She was administered chemotherapy immediately following the leukopheresis procedure. The next day we learned that the chemo had produced an effect as well: The WBC had halved again--125,000.
Induction: (4-6 wks)
anthracycline, (idarubicin or daunorubicin)
cyclophosphamide, and L-asparaginase
Consolidation: (multiple cycles of intensive chemotherapy given over a 6 to 9 month period).Cytosine arabinoside, high-dose methotrexate, etoposide anthracycline, (idarubicin or daunorubicin)
Step two was the next phase of treatment called consolidation therapy. This entailed multiple combinations of drugs administered on a rotational basis (on various weeks) for the next six months.
For instance, she would receive an infusion of methotrexate for a couple of days and then take 6-MP by mouth for a week. Another cycle included VM-26 (Teniposide) and Ara-C.
Autologous BMT : Can be curative in younger patient (< 40-50 yrs)
The Consolidation protocol had been dropped and replaced with a new induction protocol. After the bone marrow aspiration to determine the extent of the leukemia relapse, she was given doxirubicin, vincristine and L-asparaginase.
For several days following D‘s discharge from the bone marrow transplant unit, all of us loaf around the house and recuperate from our 90 day marathon…
Back in fighting form, D proceeds directly to the final 30 days of the marathon--the actual bone marrow transplant.BMT patients are in a delicate condition following discharge
As D’s hair began to grow again, we rubbed her head every night at the dinner table, wondering what color it was going to be or if it was going to be curly or straight. We never found out.
On Monday, March 1, 1999 we went to clinic and waited for the lab results. The results came back as we feared. D had relapsed. Her white count was 47,000. We were devastated.
Chemo, RT, Blood product support
Two things that I will always remember about D: She was a collector of many things, trinket boxes, key rings. But she was first and foremost a collector of "FRIENDS."