ABSTRACT
We report two cases of aplastic anaemia following exposure to 'Ecstasy' (MDMA, 3,4-methylenedioxymethamphetamine). In both cases the aplastic anaemia resolved spontaneously 7-9 weeks after presentation. Long-term bone marrow culture study of one patient demonstrated complete normalization of haemopoiesis at time of haematological recovery, suggesting either that damage to the haemopoietic stem cell had been only transient, or that a more mature, committed progenitor cell was the target. Because MDMA may have been a factor in the aetiology of the bone marrow suppression in these two cases, we recommend close haematological monitoring of young adults presenting with toxicity from MDMA, and a detailed history of exposure to recreational drugs in all new patients presenting with aplastic anaemia.
Subject(s)
Anemia, Aplastic/chemically induced , Designer Drugs/adverse effects , N-Methyl-3,4-methylenedioxyamphetamine/adverse effects , Substance-Related Disorders/complications , Adolescent , Adult , Anemia, Aplastic/blood , Anemia, Aplastic/pathology , Blood Cell Count , Bone Marrow/pathology , Cells, Cultured , Female , Follow-Up Studies , Hematopoietic Stem Cells/drug effects , Hematopoietic Stem Cells/pathology , Humans , MaleABSTRACT
Eighteen patients with chronic granulocytic leukaemia (CGL) were treated by chemoradiotherapy and transplantation of bone marrow (BMT) collected from their HLA-identical sibs; engraftment with donor marrow occurred in all cases. Ten of the patients had been subjected to splenectomy before BMT; recovery after BMT of granulocyte, lymphocyte and platelet numbers in the peripheral blood was more rapid in these patients than in the eight patients who retained their spleens. Acute graft-versus-host disease occurred in 12 of the 15 evaluable patients and appeared to be more severe in those who lacked their spleens at the time of transplant. Of the 12 patients surviving at follow-up times ranging from 59 to 207 weeks, six had been subjected to splenectomy before BMT and six retained their spleens. We conclude that engraftment was more rapid in the splenectomized patients and splenectomy might have increased the chance of eradicating the leukaemia, but these considerations must be balanced against the short-term and long-term risks associated with splenectomy.
Subject(s)
Bone Marrow Transplantation , Graft vs Host Disease/etiology , Leukemia, Myeloid/therapy , Splenectomy , Adolescent , Adult , Combined Modality Therapy , Female , Humans , Leukemia, Myeloid/blood , Leukemia, Myeloid/mortality , Leukocyte Count , Male , Platelet Count , Time FactorsABSTRACT
Thirty patients in various stages of acute leukaemia or chronic granulocytic leukaemia (CGL) were treated with cytotoxic drugs followed by whole body irradiation (TBI) administered in 200 cGy fractions twice daily to a total of 1000 or 1200 cGy. The immediate toxicity of fractionated TBI administered in this way was negligible and patients required only minor premedication and little treatment subsequently for complications attributable to TBI. Fourteen (47%) patients have died, ten of the 12 transplanted with active disease, and four of the 18 subjected to transplantation in remission of acute leukaemia or in chronic phase of CGL. Though the duration of follow-up is still short, no patient in the latter group (follow-up of survivors ranging from six to 146 weeks) has yet relapsed with any evidence of recurrent leukaemia. We conclude that this method of fractionating TBI reduced toxicity for the patient without necessarily reducing its antileukaemic effect.
Subject(s)
Bone Marrow Transplantation , Leukemia/radiotherapy , Whole-Body Irradiation , Acute Disease , Adolescent , Adult , Child , Female , Humans , Leukemia/therapy , Leukemia, Myeloid/radiotherapy , Leukemia, Myeloid/therapy , Male , Middle Aged , Radiotherapy Dosage , Whole-Body Irradiation/adverse effects , Whole-Body Irradiation/methodsSubject(s)
Leukemia, Myeloid, Acute/therapy , Thrombocythemia, Essential/therapy , Adult , Bone Marrow/pathology , Bone Marrow Transplantation , Drug Therapy, Combination , Humans , Leukemia, Myeloid, Acute/drug therapy , Leukemia, Myeloid, Acute/pathology , Male , Thrombocythemia, Essential/drug therapy , Thrombocythemia, Essential/pathologyABSTRACT
In 1979 two patients with Philadelphia (Ph1)-chromosome-positive chronic granulocytic leukaemia (CGL) were treated with chemoradiotherapy and transplantation of bone marrow from their respective identical twins. Subsequently twelve patients with Ph1-positive CGL in chronic phase were treated with chemoradiotherapy followed by transplantation of bone marrow from their HLA-identical sibs. Two of the fourteen patients have died of complications of the transplant procedure; twelve patients are alive and well. All the survivors have normal or nearly normal blood counts; there is no evidence of recurrent leukaemia or Ph1-positive cells in any patient after follow-up periods ranging from 97 to 1112 days. Bone-marrow transplantation should be considered in the management of any young patient with CGL who has a suitable marrow donor.
Subject(s)
Bone Marrow Transplantation , Leukemia, Myeloid/therapy , Adolescent , Adult , Antineoplastic Agents/administration & dosage , Child , Chromosomes, Human, 21-22 and Y , Drug Therapy, Combination , Female , HLA Antigens/genetics , Humans , Leukemia, Myeloid/genetics , Leukemia, Myeloid/mortality , Male , Postoperative Complications/mortality , Preoperative Care , Random Allocation , Transplantation, IsogeneicABSTRACT
Paraproteinaemia may be associated with xanthomatous skin deposits and these can arise in the absence of elevated lipid levels. Two cases of benign monoclonal gammopathy with diffuse plane xanthomatosis are reported. Case 1 exhibited hypolipidaemia and a functional deficiency of C1 esterase inhibitor. Case 2 showed a normal lipoprotein profile, abnormal platelet aggregation, and a cutaneous vasculitis with evidence of complement consumption via the classical pathway. The significance of these abnormalities is discussed.
