Isolated testicular relapse in acute lymphocytic leukemia of childhood: categories and influence on survival.

1984 ◽  
Vol 2 (8) ◽  
pp. 924-929 ◽  
Author(s):  
W P Bowman ◽  
R J Aur ◽  
H O Hustu ◽  
G Rivera
Keyword(s):  
Bone Marrow ◽  
Complete Remission ◽  
Acute Lymphocytic Leukemia ◽  
Clinical Course ◽  
Late Recurrence ◽  
Lymphocytic Leukemia ◽  
Drug Resistant ◽  
Prognostic Features ◽  
Resistant Disease ◽  
Testicular Disease

Isolated testicular relapse complicating first hematologic remission was identified in 31 of 521 boys with acute lymphocytic leukemia (ALL). Three categories of involvement were apparent and could be related to presenting clinical features, duration of initial complete remission, and length of hematologic remission. Among 12 patients with early testicular relapse, most had unfavorable prognostic features when ALL was first diagnosed. All but two of these children experienced marrow recurrence within seven months of testicular relapse. In contrast, the 12 patients who developed testicular disease late in their clinical course have responded much better to further therapy; ten remain in bone-marrow remission for a median of four years beyond testicular relapse. Similarly, five of the seven patients with subclinical testicular leukemia, found at elective biopsy, continue in marrow remission for prolonged periods. Early testicular recurrence is a sign of drug-resistant disease; late recurrence after elective cessation of therapy may represent residual, incompletely treated but still responsive leukemia.

scholarly journals The Significance of Bone Marrow Lymphocytosis of Acute Leukemia Patients in Remission

Blood ◽  
1968 ◽  
Vol 32 (5) ◽  
pp. 767-773 ◽  
Author(s):  
ROLAND T. SKEEL ◽  
EDWARD S. HENDERSON ◽  
JOHN M. BENNETT
Keyword(s):  
Bone Marrow ◽  
Complete Remission ◽  
Acute Leukemia ◽  
Median Survival ◽  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
The Past ◽  
Remission Status ◽  
Remission Duration ◽  
Subsequent Relapse

Abstract Bone marrow lymphocytosis (BML) 20 per cent or greater occurring during remission of acute leukemia has been looked upon in the past as an unfavorable sign that may presage early subsequent relapse. Seventy-four patients with acute lymphocytic leukemia were studied to evaluate the significance of BML in remission. It was found that 14 patients with less than 20 per cent bone marrow lymphocytes at any time in remission had a median remission duration of 3 months and a median survival of 21 months, while 60 patients with 20 per cent or more bone marrow lymphocytes at any time in remission had a median remission duration of 14 months and a median survival time of 34 months. Patients with AGL and lymphocytosis had remissions and survivals not significantly longer than those without lymphocytosis It is concluded that there is no justification for excluding a patient from complete remission status because of bone marrow lymphocytosis.

Stewart Smiled

PEDIATRICS ◽  
1993 ◽  
Vol 91 (5) ◽  
pp. 1018-1018
Author(s):  
JIM K. BAXTER
Keyword(s):  
Bone Marrow ◽  
Eighteenth Century ◽  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Medical Forms

To the Editor.— Stewart smiled during the spinal tap that lasted only moments. Kneeling down close, I whispered that I was proud of him, and a great little smile lit the room. It had not been that long since this procedure had my 4-year-old son surrounded by the strong arms of nurses in the great lock and shout down, straight from the eighteenth century. Somewhere in the weeks that followed our diagnosis of acute lymphocytic leukemia, somewhere lost in that downpour of emotions and medical forms, my wife and I agreed to enroll Stewart in a study that would compare two different sedation drugs and their effects during lumbar punctures and bone marrow tests.

scholarly journals Left shift in the peripheral blood count at diagnosis in acute lymphocytic leukemia is significantly correlated with duration of complete remission

Blood ◽  
1984 ◽  
Vol 63 (1) ◽  
pp. 216-218 ◽  
Author(s):  
BJ Shen ◽  
H Ekert ◽  
GP Tauro ◽  
A Balderas
Keyword(s):  
Complete Remission ◽  
Peripheral Blood ◽  
Acute Lymphocytic Leukemia ◽  
Blood Count ◽  
Prognostic Significance ◽  
Lymphocytic Leukemia ◽  
Indirect Measure ◽  
Cox Regression Analysis ◽  
Peripheral Blood Count ◽  
Left Shift

Abstract The prognostic significance of a left shift in the peripheral blood at the time of diagnosis of acute lymphocytic leukemia was investigated by a retrospective analysis of 109 patients treated on the same protocol in a single institution. Left shift was defined as the presence of 1% or more of metamyelocytes, myelocytes, or promyelocytes. All peripheral blood films were checked at the time of diagnosis by one of the authors. It was found that the duration of complete remission at 92 mo was 74% in patients with left shift and 42% in those without left shift (p less than 0.05, log-rank test). By Cox regression analysis, only the total white cell count (p less than 0.001) and the presence or absence of left shift (p less than 0.01) were independently significant in determining the proportion of patients in complete remission. Patients with a left shift had a significantly higher granulocyte count at diagnosis (p less than 0.05). We postulate that left shift in the peripheral blood count at the time of diagnosis may be an indirect measure of the total leukemia cell load. It is a new prognostic factor of significance in determining the likely outcome of the disease.

scholarly journals Intensive therapy followed by bone marrow transplantation for patients with acute lymphocytic leukemia in second or subsequent remission: determination of prognostic factors (a report from the University of Minnesota Bone Marrow Transplantation Team)

Blood ◽  
1983 ◽  
Vol 61 (6) ◽  
pp. 1182-1189 ◽  
Author(s):  
WG Woods ◽  
ME Nesbit ◽  
NK Ramsay ◽  
W Krivit ◽  
TH Kim ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Acute Lymphocytic Leukemia ◽  
Intensive Therapy ◽  
Lymphocytic Leukemia ◽  
Maintenance Chemotherapy ◽  
Extramedullary Disease ◽  
Rate Versus ◽  
Disease Free

Abstract Fifteen patients with acute lymphocytic leukemia (ALL) in second or subsequent remission received intensive therapy with cyclophosphamide and single dose, rapid rate (26 cGy/min) total body irradiation (TBI) followed by bone marrow transplantation (BMT) from a histocompatible sibling match. Outcome was compared to that of 23 conventionally treated control patients in second ALL remission who presented to the same institution during the same time period but had no available transplant donor. The 15 BMT patients and 23 control patients had similar characteristics, with the exception that the BMT patients were significantly older at the time of ALL diagnosis (12.6 yr versus 5.7 yr, p = 0.01). BMT patients had a significantly increased chance of remaining disease-free for 36 mo from time on study (43% actuarial versus 5%, p = 0.004) and a greater overall survival rate at 48 mo (47% actuarial versus 9%, p = 0.27) than the conventionally treated patients. In all, 5 of the bone marrow transplant patients (33%) remain alive and free of disease 24–48 + mo from transplantation. Several pre- and posttransplant characteristics were analyzed to determine predictive factors for a successful BMT outcome for patients with ALL in second or subsequent remission. Significant risk factors for predicting leukemic relapse included initial white blood count (WBC) greater than 50,000/microliters at ALL diagnosis (100% relapse rate versus 37% for patients with lower WBCs, p = 0.001) and presence of any extramedullary disease pre-BMT (100% relapse rate versus 37% for patients without extramedullary disease, p = 0.03). All 5 disease-free BMT survivors had initial WBCs less than 50,000/microliters and no evidence of extramedullary disease pretransplantation. Maintenance chemotherapy with 6-mercaptopurine (6MP) and methotrexate was given to four patients starting 100 days after bone marrow transplantation. Use of maintenance chemotherapy was associated with a significantly increased chance of remaining disease free (100% of patients surviving leukemia-free versus 17% for patients not receiving maintenance chemotherapy, p = 0.02). Presence of graft-versus-host disease (GVHD) did not influence leukemia-free survival. These results confirm that intensive therapy followed by bone marrow transplantation is the treatment of choice for patients with ALL in second or subsequent remission who have a histocompatible sibling match. Furthermore, the data suggest that a controlled trial to evaluate the efficacy of maintenance chemotherapy post-BMT for ALL patients is warranted.

scholarly journals Central Nervous System Therapy and Combination Chemotherapy of Childhood Lymphocytic Leukemia

Blood ◽  
1971 ◽  
Vol 37 (3) ◽  
pp. 272-281 ◽  
Author(s):  
RHOMES J. A. AUR ◽  
JOSEPH SIMONE ◽  
H. OMAR HUSTU ◽  
THOMAS WALTERS ◽  
LUIS BORELLA ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Complete Remission ◽  
Combination Chemotherapy ◽  
Acute Lymphocytic Leukemia ◽  
Viral Infections ◽  
Combined Therapy ◽  
Lymphocytic Leukemia ◽  
Intrathecal Methotrexate ◽  
Central Nervous System Relapse

Abstract In earlier combination chemotherapy regimens for childhood acute lymphocytic leukemia, nervous system leukemia terminated complete remission in over half the patients in a median time of 11 months. In the present study, cranial radiation (2400 R, 60Co) and intrathecal methotrexate given early in remission were added to combination chemotherapy in an attempt to prevent or delay central nervous system relapse and termination of complete remission. Of 35 consecutive children with previously untreated acute lymphocytic leukemia, 20 of 30 who attained remission and received all initial phases of therapy have been in continuous complete remission for 23 to 30 months. Complete remission was terminated by nervous system relapse in three patients and by hematological relapse in five. Two patients died in complete remission of viral infections and others experienced reversible drug toxicity. We conclude that this combined therapy reduces the incidence of nervous system relapse in the first 2 years and prolongs complete remission.

scholarly journals Transplantation of HL-A Identical Allogeneic Bone Marrow to a Patient With Acute Lymphocytic Leukemia

Blood ◽  
1970 ◽  
Vol 36 (6) ◽  
pp. 736-747 ◽  
Author(s):  
ROBERT G. GRAW ◽  
JAMES A. BROWN ◽  
RONALD A. YANKEE ◽  
BRIGID G. LEVENTHAL ◽  
JACQUELINE WHANG-PENG ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Graft Versus Host Reaction ◽  
Blood Component ◽  
Allogeneic Bone ◽  
Allogenic Bone ◽  
Conventional Drug

Abstract An 8-year-old boy with acute lymphocytic leukemia, no longer responsive to conventional chemotherapy after 2 years, was successfully grafted with bone marrow from his HL-A genotypically identical 10-year-old sister. Prior to transplantation, he had received 141 blood component transfusions and had become sensitized to histocompatibility antigens (HL-A), as demonstrated by the presence of circulating lymphocytotoxic antibodies. Except for the occurrence of a possible mild graft-versus-host-reaction and a documented cytomegalovirus infection, the patient remained clinically well until full return of his leukemia 91 days after the transplant. This case demonstrates that bone marrow transplantation can be accomplished between HL-A identical siblings even though the recipient may have been previously sensitized to other HL-A antigens by earlier transfusion. Allogenic bone marrow transplantation offers the opportunity for remissions in patients with leukemia unresponsive to conventional drug therapy.

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