Leukemic dermal infiltrates at permanent central venous catheter insertion sites

Article Abstract:

While leukemia is often thought of as a blood disease, it must be remembered that leukemic cells may infiltrate various organs and tissues. Monocytic and myelomonocytic leukemias commonly invade skin and soft tissues, which is presumed to be related to the role of the normal counterparts of these leukemic cells, which can crawl through tissues as a part of their role in immune defenses. The wound in the skin which is necessary to permit catheterization of a blood vessel serves as a potential pathway for the invasion of the skin by leukemic cells; since venous catheters are often inserted for the administration of chemotherapy, the potential for leukemic invasion of the insertion site must not be forgotten. The authors describe three cases in which leukemic cells invaded the skin through this route. In all three cases, a mass developed at the site where the catheter entered the body; in one case a purulent ulcer developed at that site. Radiation was applied to the site of the catheter insertion, but in two cases the patients were already suffering serious progression at the time the leukemic masses in the catheter sites became apparent. In one patient the mass developing at the site of the indwelling catheter provided the first indication that all was not well after 11 months of complete remission. Further examination revealed similar masses at sites where blood specimens had been drawn. These lesions responded to radiation treatment, but this patient ultimately succumbed to disease recurrence in the bone marrow. Among patients with leukemia, any mass or lesion which fails to heal at the site of a catheter insertion should be treated with suspicion and biopsied immediately. (Consumer Summary produced by Reliance Medical Information, Inc.)

Catheterization

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Cutaneous toxicity of autologous bone marrow transplantation in nonseminomatous germ cell tumors

Article Abstract:

Autologous bone marrow transplantation is used to treat some cancers that are refractory to more conventional treatment. Since bone marrow toxicity is the dose-limiting feature of many chemotherapeutic drugs, higher doses can be achieved by removing some bone marrow, administering the drug treatment regimen, and then replacing the patient's own bone marrow at a later date. It seems likely, however, that as the chemotherapeutic doses are increased, new toxic effects will come to light. This is what has happened in the cases of two of eight patients treated for nonseminomatous germ cell tumors. Both patients underwent autologous bone marrow transplantation as a part of their treatment with a combination of cisplatin and carboplatin with etoposide and cyclophosphamide. Skin damage evolved which was reminiscent of radiation damage. A mild edema and generalized redness with a burning sensation was followed by the eruption of vesicles. The lesions were most common on areas of the skin usually exposed to the sun. Although the reaction is almost certainly the result of the intensified drug regimen, it is impossible to determine the precise cause. It should be emphasized, however, that these patients have a cancer of poor prognosis, yet the treatment protocol seems able to sustain extended periods of remission. One patient is alive at 30 months in complete remission and the other is alive at 31 months with no evidence of disease. Both patients are suffering from polyneuritis and deafness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Germ cell tumors, Germinoma, Chemotherapy, Cisplatin, Carboplatin

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Central nervous system relapses after bone marrow transplantation for acute lymphoblastic leukemia in remission

Article Abstract:

The central nervous system (CNS) can serve as a sanctuary for leukemic cells during radiation or chemotherapy. Consequently, the CNS is a potential site for relapse. In a study of 82 patients with acute lymphoblastic leukemia, 8 patients with lymphoblastic lymphoma, and 2 with Burkitt's lymphoma, the risk factors for CNS relapse following chemotherapy, radiotherapy and bone marrow transplantation (BMT) were tabulated. Prophylactic cranial irradiation, and intrathecal injection (within the spinal canal) of methotrexate, designed to hit leukemic cells hiding in the nervous system, may probably be omitted in BMT patients when there is no history of CNS involvement. In such cases, the CNS relapse rate was only 3.4 percent following BMT when total body irradiation was included in therapy. However, of cases in which there was a history of CNS involvement, the probability of CNS relapse rose to 27.5 percent. Of the patients with a previous history of CNS involvement, those who received allogeneic bone marrow, that is from another donor, fared much better than those who received an autologous donation of their own bone marrow. It has been suggested that this may be due to graft bone marrow cells destroying leukemic cells in the nervous system. However, it is impossible to attribute the effect to a specific cause since the recipients of allogeneic bone marrow also received a different treatment regimen which included methotrexate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Causes of, Central nervous system diseases, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, Lymphocytic leukemia

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