ABSTRACT
Therapy-related myelodysplastic syndrome (t-MDS) and therapy-related acute myelogenous leukemia (t-AML) in patients with acute promyelocytic leukemia (APL) are rare events. The cumulative exposure to chemotherapy with alkylating agents and topoisomerase II inhibitors is associated with t-AML that may develop any time after the completion of the treatment. We report the case of an acquired AML who previously received therapy for APL, after two years of being diagnosed. The diagnosis was established by morphologic findings, membrane markers, cytogenetic studies, and fluorescence in situ hybridization (FISH). To our knowledge this is the first documented case in Puerto Rico of a patient with APL that developed a t-AML without the characteristic chromosomal and morphologic findings of APL.
Subject(s)
Leukemia, Myeloid, Acute/etiology , Leukemia, Promyelocytic, Acute/drug therapy , Neoplasms, Second Primary/etiology , Translocation, Genetic , Adult , Antineoplastic Agents, Alkylating/administration & dosage , Antineoplastic Agents, Alkylating/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chromosomes, Human, Pair 15/ultrastructure , Chromosomes, Human, Pair 17/ultrastructure , Chromosomes, Human, Pair 21/ultrastructure , Chromosomes, Human, Pair 3/ultrastructure , Chromosomes, Human, Pair 7 , Cytarabine/administration & dosage , Daunorubicin/administration & dosage , Daunorubicin/adverse effects , Drug Synergism , Fatal Outcome , Humans , Leukemia, Myeloid, Acute/drug therapy , Leukemia, Myeloid, Acute/genetics , Leukemia, Promyelocytic, Acute/genetics , Male , Mercaptopurine/administration & dosage , Methotrexate/administration & dosage , Methotrexate/adverse effects , Mitoxantrone/administration & dosage , Mitoxantrone/adverse effects , Monosomy , Neoplasms, Second Primary/genetics , Tretinoin/administration & dosageABSTRACT
Aleukemic leukemia cutis is an extremely rare clinical presentation in patients who eventually develop acute leukemia, usually of monocytic lineage. This condition is associated with a very poor prognosis and is often difficult to diagnose. We report a case of a 33 years old female with leukemia cutis preceding the onset of acute monocytic leukemia by four months. The patient received induction and consolidation chemotherapy followed by allogeneic bone marrow transplant and has been free of disease for six years. To our knowledge, this is the first documented case in Puerto Rico with the diagnosis of leukemia cutis preceding acute monocytic leukemia.
Subject(s)
Leukemia, Monocytic, Acute/pathology , Leukemic Infiltration , Skin/pathology , Female , Humans , Leukemia, Monocytic, Acute/therapy , Middle AgedABSTRACT
Fifty three adult patients with idiopathic thrombocytopenic purpura (ITP) were diagnosed at the University District Hospital (UDH) during the last 10 years (1976-1986). There were 33 females (62%) and 20 males (38%). All the patients were over 15 years old with a mean age of 3o years. Only 13 patients gave a history of a viral syndrome preceding the onset of symptoms. The most frequent chief complaint was petechiae and/or ecchymotic lesions. The mean initial platelet count was 10,000/mm. Bone marrow aspiration showed an increased number of megakaryocytes without platelet production in 49 patients (86%). Of the fifty three patients, 37 (70%) had a complete response to steroids. Of those not responding to steroids, 15 underwent splenectomy and 11 (73%) achieved a permanent response. Immunosupresion was prescribed in 4 patients with a 50% complete response
Subject(s)
Adult , Humans , Female , Purpura, Thrombocytopenic/diagnosis , Adrenal Cortex Hormones/therapy , Age Factors , Platelet Count , Purpura, Thrombocytopenic/therapy , SplenectomyABSTRACT
La presentación simultánea de mieloma múltiple y otras enfermedades hematológicas en un mismo paciente, se observa en muy rar as ocasiones. Se han publicado muy pocos casos en la literatura en que coexiste mieloma múltiple y leucemia aguda. En la mayoría de estos casos los pacientes presentaron la leucemia después de haber recibido tratamiento prolongado con agentes alquilantes, razón por la cual se ha implicado a estos como posible factor etiológico causal de la leucemia. Durante los últimos 14 años hemos seguido 141 pacientes con mieloma múltiple en el Hospittal Universitario, de los cuales 3 (2.1%) presentaron posteriormente leucemia aguda. Dos pacientes eran mujeres de 48 y 49 años y uno varón de 33 años. El diagnóstico de mieloma múltiple se estableció por la presencia de un pico protéico monoclonal en suero, lesiones óseas líticas y la presencia de una plasmacitosis inmafuera en la méfuela ósea. Los tres pacientes fueron tratados con agentes alquilantes por 2,9 y 10 años respectivamente antes del inicio de la leucemia. El evento inicial en dos de los casos fue trombocitopenia, alteraciones morfológicas de las plaquetas en uno de los pacientes y la presencia de células inmafueras en la sangre periférica. La transformación en los tres casos fue a leucemia aguda mielógena. Dos de los pacientes recibieron terapia antileucémica fuerante 9 y 11 meses respectivamente. El cuadro clínico de los tres pacientes se describe en detalle y se revisa la literatura pertinente
