Subject(s)
Chromosomes, Human, Pair 5 , Ferrochelatase/genetics , Gene Deletion , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Protoporphyria, Erythropoietic/genetics , Age of Onset , Bone Marrow Cells , Fatal Outcome , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/genetics , Male , Middle Aged , Photosensitivity Disorders/congenital , Protoporphyria, Erythropoietic/diagnosisABSTRACT
A case of Philadelphia-positive (Ph) acute lymphoblastic leukaemia (ALL) in a 40-year-old male is presented. At diagnosis, 80% of bone marrow cells were Ph. Remission with normal blood counts was achieved but the marrow became hypercellular, indicating conversion to chronic granulocytic leukaemia (GCL). The Ph clone persisted with a variable percentage of Ph cells. He developed testicular relapse 38 months from diagnosis. The patient died when engraftment with a matched unrelated bone marrow transplant failed. Molecular investigation of DNA prepared from diagnostic and remission bone marrow and from testicular tissue in relapse revealed the same sized rearranged fragment of the BCR gene using a probe to the major breakpoint cluster region. This case confirms that testicular involvement due to infiltration of the testes by the original Ph leukaemic clone may occur as an unusual complication in Ph ALL. Conversion to chronic-phase GCL, a rare occurrence in Ph ALL, may have contributed to the unusually long survival.
Subject(s)
Neoplasm Recurrence, Local/diagnosis , Philadelphia Chromosome , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Testicular Neoplasms/secondary , Adult , Combined Modality Therapy , DNA, Neoplasm/analysis , DNA, Neoplasm/genetics , Gene Rearrangement , Genes, abl , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Male , Neoplasm Recurrence, Local/genetics , Neoplasm Recurrence, Local/therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Remission Induction , Testicular Neoplasms/diagnosis , Testicular Neoplasms/genetics , Testicular Neoplasms/therapyABSTRACT
Granulomas are thought to represent an immune reaction to antigenic stimulation. Bone marrow granulomas are uncommon, but in the following case report we show their transient appearance after interleukin 2 (IL-2) and autologous lymphokine-activated killer cell therapy. This is a previously unreported association, and may implicate IL-2 in the pathogenesis of granulomas.
Subject(s)
Bone Marrow Diseases/etiology , Granuloma/etiology , Interleukin-2/adverse effects , Killer Cells, Lymphokine-Activated , Leukemia, Myelomonocytic, Acute/therapy , Adult , Humans , Interleukin-2/therapeutic use , MaleABSTRACT
Twenty-five patients with relapsed or primary resistant Hodgkin's Disease were treated with high dose combination chemotherapy comprising cyclophosphamide, carmustine (BCNU) and etoposide followed by autologous bone marrow transplantation (ABMT). Sixteen (67%) of the twenty-four patients who survived the treatment schedule attained complete response (CR) and eleven of these remain disease free at a median time post ABMT of 16 months (range 6 to 27 months). Two of the patients who relapsed died at 7 and 17 months and the remaining three patients are alive with persistent disease at 12, 14 and 18 months. Four patients showed partial response. Three of these developed disease progression soon after the procedure and all died within ten months. The remaining patient achieved CR following further chemotherapy. There was a tendency for patients with bulky mediastinal disease, extra-nodal disease and heavy pre-treatment to fail to achieve CR.
