Spontaneous remission of acute lymphoblastic leukemia: A series of nine cases and a review of literature.

AIMS: To report a series of acute lymphoblastic leukemia (ALL) cases with spontaneous remission and provide presenting clinical and pathologic information and details of clinical course to raise awareness among oncologists and patients. METHODS: We identified and analyzed nine patients with ALL and spontaneous remission. Review of literature reveals an additional nine previously reported cases with similar clinical course. RESULTS: All of these patients, ranging in age from 2 to 12 years of age, presented with inciting signs and symptoms of viral or bacterial infection. All of the patients showed varying percentages of lymphoblasts (.2% to 90%) in diagnostic bone marrow biopsy. All B-ALL cases shared a similar blast phenotype on flow cytometry with coexpression of CD19, CD10 and TdT and variable CD20 expression. All nine patients achieved spontaneous remission of their leukemia as confirmed by flow cytometry and/or bone marrow biopsy without chemotherapeutic intervention. Time to remission from presentation ranged from 1 to 8 weeks. After remission, all patients redeveloped ALL, and time from remission to reemergence ranged from 2 to 24 weeks. CONCLUSION: Our series of cases and cases identified in literature show that ALL diagnosed with modern methods of flow cytometry and molecular analysis will recur within weeks to months from disappearance, usually with cytopenias, which provides a template for oncologic follow-up and testing in these patients.

Thrombotic Microangiopathy in the Setting of Colorectal Cancer: A Therapeutic Challenge with a Bad Prognosis.

While most cases of thrombotic microangiopathic hemolytic anemias are idiopathic, some can occur in the setting of a malignancy. Differentiating both conditions is crucial to initiate the appropriate treatment. In this case report and literature review, we discuss the occurrence of a thrombotic microangiopathy in a 61-year-old male patient with a treatment-refractory metastatic colorectal cancer invading his bone marrow. Plasmapheresis does not constitute the mainstay of treatment in this setting, as targeting the primary disease is the ultimate management. Treating the condition of our patient has been challenging as multiple lines of treatments of his primary disease had been exhausted. The discrepancy in KRAs status obtained between PCR and later NGS offered a new treatment line with Cetuximab. In this article, we will discuss the different factors that differentiate between idiopathic and cancer-induced microangiopathy. We will emphasize on the fact that the treatment of the primary disease constitutes the most important step in the treatment of cancer-induced thrombotic microangiopathy. We will also raise several explanations to target the disagreement in KRAS status obtained by the different technical modalities.

The feasibility of solar-powered small-scale brackish water desalination units in a coastal aquifer prone to saltwater intrusion: A comparison between electrodialysis reversal and reverse osmosis.

In the face of increasing water shortages worldwide, water desalination has the potential to expand the available freshwater supply options in many water stressed regions. This paper assesses the feasibility of adopting photovoltaic powered small-scale brackish water desalination units in a coastal aquifer facing saltwater intrusion and chronic water shortages. Moreover, a detailed cost comparison, which incorporates the associated environmental costs, is conducted between the Electrodialysis Reversal (EDR) technique and Reverse Osmosis (RO). The results showed that PV-powered small-scale desalination units were more economically viable as compared to grid-powered units, when the electricity tariffs reflected non-subsidized electricity prices and environmental costs were internalized. EDR-PV proved to be more economically feasible and with a lower environmental footprint as compared to RO-PV, up until the salinity of the aquifer was below 5000 ppm (EDR: 0.57-1.18 $/m3; RO = 1.19-1.59 $/m3). Beyond that salinity, the RO-PV was found to be the more economically viable option, with costs reaching as high as 2.65 $/m3 at a salinity of 25,000 ppm. Overall, the environmental costs between the two technologies varied significantly, largely due to differences in the generated brine volume, with EDR having better efficiencies at lower salinity levels. Finally, the study highlighted the risk of accelerating saltwater intrusion as a result of the increased market penetration of solar-powered desalination units along vulnerable coastal aquifers.