Acute Lymphoblastic Leukaemia: A Case Report of Long-term Disease-free Survival in a Resource Limited Setting

2020 ◽  
Vol 3 (4) ◽  
pp. 457-462
Author(s):  
ED Jatau ◽  
DE Joseph ◽  
JO Egesie ◽  
OD Damulak ◽  
TO Piwuna ◽  
...  
Keyword(s):  
Case Report ◽  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Disease Free Survival ◽  
Bone Marrow Aspiration ◽  
Lymphoid Cells ◽  
Full Blood Count ◽  
Clinical Relapse ◽  
High Index Of Suspicion ◽  
Disease Free

Acute Lymphoblastic Leukaemia (ALL) a malignant proliferation of immature lymphoid cells is a biologically heterogeneous disorder with variable outcomes in adults. We present a case report of a 54-year-old woman who presented with fever, anaemia and peripheral lymphadenopathy of four weeks duration, and was managed for disseminated tuberculosis initially. Full blood count and bone marrow aspiration cytology constituted part of her initial investigations and were found to be in keeping with acute lymphoblastic leukaemia (ALL-L3). Patient had supportive treatment and managed with Cyclophosphamide, Vincristine (Oncovin), Cytosine Arabinoside and Prednisolone (COAP Regimen), achieved complete clinical and haematologic remission, and has remained disease free after consolidation and maintenance therapy. No evidence of haematologic or clinical relapse at five years and currently in her ninth-year post diagnosis and treatment. With high index of suspicion, timely investigation and referral, satisfactory outcomes are achievable in managing some patients with acute lymphoblastic leukaemia.

scholarly journals Extensive Bone Marrow Necrosis: A Rare Presentation of Acute Lymphoblastic Leukaemia

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
I. Ranathunga ◽  
N. R. Muthumala ◽  
H. W. C. K. Kulathilake ◽  
S. Weerasinghe ◽  
N. L. A. Shyamali
Keyword(s):  
Bone Marrow ◽  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Bone Marrow Aspiration ◽  
Blood Film ◽  
Lymphoid Cells ◽  
Severe Neutropenia ◽  
Bone Marrow Necrosis ◽  
Rare Presentation ◽  
Extensive Necrosis

Background. Bone marrow necrosis (BMN) is a rare entity which presents with bone pain, fever, and peripheral cytopenia. Acute lymphoblastic leukaemia (ALL) is characterized by malignant proliferation of immature lymphocytes, and patients usually present with fatigue and bleeding manifestations. Presentation with BMN is an extremely rare finding and only few cases had been reported in the literature. Case Presentation. A 22-year-old male presented with nocturnal lower back ache, pleuritic central chest pain, and fever for two weeks. He was extensively investigated for a cause. His investigations revealed pancytopenia with severe neutropenia. Initial bone marrow aspiration and biopsy did not provide a positive result due to extensive necrosis. However, immunohistochemical analysis of few immature lymphoid cells on repeated BM biopsy showed evidence of acute lymphoblastic leukaemia. Conclusions. ALL usually presents with fatigue and bleeding manifestations. Presentation with BMN is extremely rare. The diagnosis was extremely challenging as this patient had only occasional atypical cells in the peripheral blood film and the repeat bone marrow (BM) biopsy showed extensive necrosis.

scholarly journals Thirteen-Year Disease-Free Survival after Surgery for Cystic Duct Carcinoma: A Case Report

2008 ◽  
Vol 2 (3) ◽  
pp. 428-432 ◽  
Author(s):  
Zine Abedine Benchellal ◽  
Kountélé Gona Soro ◽  
Isabelle Orain ◽  
Hélène Poret ◽  
Abd Hak Ferhi ◽  
...  
Keyword(s):  
Case Report ◽  
Cystic Duct ◽  
Disease Free Survival ◽  
Duct Carcinoma ◽  
Free Survival ◽  
Cystic Duct Carcinoma ◽  
Disease Free

Nordic Mantle Cell Lymphoma (MCL) Project: Preemptive Rituximab Treatment of Molecular Relapse Following Autotransplant Can Reinduce Molecular Remission and Prolonged Disease-Free Survival.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2429-2429
Author(s):  
Christian H. Geisler ◽  
Erkki Elonen ◽  
Arne Kolstad ◽  
Anna Laurell ◽  
Lone B. Pedersen ◽  
...  
Keyword(s):  
Stem Cell ◽  
Cell Lymphoma ◽  
Disease Free Survival ◽  
High Dose ◽  
Clinical Relapse ◽  
Relapse Free Survival ◽  
Molecular Remission ◽  
Free Survival ◽  
Mantle Cell ◽  
Disease Free

Abstract The 2nd. Nordic Lymphoma Group mantle cell lymphoma (MCL2) protocol has demonstrated the importance of Ara-C and Rituximab in the induction chemotherapy and stem-cell mobilisation before high-dose therapy and autologous stem-cell transplant (1). By July 2005, 128 patients (83% stage IV) had completed protocol treatment consisting of 3 series of R-CHOP and 3 series of R-Ara-C, stem-cell harvest and high-dose therapy with BEAM/BEAC with ASCT. The 5-year failure-free and overall survival is 50% and 83% respectively, significantly higher than the historic control group of the Nordic MCL1 protocol with the same treatment without HD-Ara-C and Rituximab (P<0.0001). Patients with a molecular marker (t(11;14) or clonal IgH rearrangement) identified at the time of diagnosis in bone marrow and blood, undergo regular molecular follow-up posttransplant,. Patients who turn PCR-positive or increase their qPCR signal, without clinical disease, are offered preemptive treatment with Rituximab 375 mg/m2 Wx4. Of 75 patients with molecular markers who had completed treatment, 55 remain PCR-negative and 20 have become/remained PCR-pos. posttransplant. Clinical relapse ocurred significantly more often in the latter group (11 of 20) than in the PCR-neg. patients (4 of 55) (P<0.0001) (Fig.1). Ten of the 20 PCR-positive patient did not receive preemptive rituximab: five due to immediate clinical relapse, 2 due to stable qPCR signals, one due to protocol error and two await treatment. Of 10 patients who did receive preemptive rituximab 8 again became PCR-negative and 2 remain PCR-positive. Six of the 10 Rituximab treated patients remain in clinical and molecular remission 200–600 days after the Rituximab treatment (Fig. 2). Conclusions: In MCL, molecular relapse is a harbinger of imminent clinical relapse, whereas continuous molecular remission is associated with prolonged disease-free survival (89% at 4 years) Rituximab preemptive treatment can reinduce molecular remission and may delay clinical relapse. Following molecular relapse, only Rituximab treated patients (6 of 8 evaluable) remain disease-free. FIG. 1. NORDIC NCL-2 PROTOCOL: RELAPSE-FREE SURVIVAL ACC. TO MOLECULAR STATUS POSTTRANSPALNT FIG. 1. NORDIC NCL-2 PROTOCOL: RELAPSE-FREE SURVIVAL ACC. TO MOLECULAR STATUS POSTTRANSPALNT FIG. 2. NORDIC NCL-2 PROTOCOL: RELAPSE-FREE SURVIVAL FROM TIME OF MOLECULAR RELAPSE. FIG. 2. NORDIC NCL-2 PROTOCOL: RELAPSE-FREE SURVIVAL FROM TIME OF MOLECULAR RELAPSE.

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