Off-pump coronary artery bypass grafting in a patient with chronic myelomonocytic leukemia

We report the case of a 71-year-old man with chronic myelomonocytic leukemia who developed cardiogenic shock twice due to a stenosis of the left main trunk of the coronary artery. We performed coronary artery bypass grafting to the left anterior descending artery with the left internal thoracic artery without using a cardiopulmonary bypass. The patient had no infection, leukemic transformation, or cardiac event after the surgery. Off-pump coronary artery bypass grafting is safe and useful for high risk patients, such as those with leukemia.     

Long survival of a patient presented with blastic crisis of chronic myelomonocytic leukemia

A 77-year-old man was diagnosed as having acute myelomonocytic leukemia (M4) with increased ringed sideroblasts in the bone marrow (BM) in October, 1979. Complete remission was achieved and ringed sideroblasts disappeared after two courses of CMP (cytarabine, 6-mercaptopurine, prednisolone) therapy. Following remission, there was no increase of blasts during the course of the disease, but monocytosis and dysmyelopoiesis persisted for about seven years. The monocytosis was controlled by 6-mercaptopurine. In June, 1986, however, monocytosis in peripheral blood (PB) and BM developed again, and there was severe pancytopenia and reappearance of ringed sideroblasts without increase of blasts. The patient died of pneumonia on September, 1986. Postmortem examination revealed hypercellular marrow with a few blasts, leukemic cell infiltration into spleen, liver and lymph nodes, ad lung cancer. His clinical and hematological features after remission of acute leukemia accorded with those of CMMoL. The dysmyelopoiesis observed in this case in not induced by anti-leukemic agents, but originated from the same clone as the initial AMMoL, and his disease was thought to be CMMoL converted from blastic crisis to chronic phase.     

Specific cutaneous infiltrate caused by Staphylococcus aureus in a patient with chronic myelomonocytic leukemia

We present a patient with chronic myelomonocytic leukemia who showed disseminated papules and nodules. Arguments in favor of leukemia cutis are the clinical appearance, the cyclic pattern with which the lesions appeared and disappeared, and the histologic features. The lesions reproducibly responded to treatment with antibiotics given for a Staphylococcus aureus infection. We speculate that at least in some patients, leukemic cells are recruited in the skin because of local infection and do not merely reflect autonomous growth but an inflammatory response. Received: 12 August 1999 / Accepted: 9 December 1999     

Adult Burkitt leukemia and lymphoma

The World Health Organization Classification of Lymphoid Neoplasms identifies Burkitt lymphoma/leukemia as a highly aggressive mature B-cell neoplasm consisting of endemic, sporadic, and immunodeficiency-associated variants. These subtypes share many morphologic and immunophenotypic features, but differences exist in their clinical and geographic presentations. All of these subtypes possess chromosomal rearrangements of the c-myc oncogene, the genetic hallmark of Burkitt lymphoma that contributes to lymphomagenesis through alterations in cell cycle regulation, cellular differentiation, apoptosis, cellular adhesion, and metabolism. Brief-duration, high-intensity chemotherapy regimens containing aggressive central nervous system prophylaxis have had remarkable success in the treatment of this disease, with complete remission rates of 75% to 90% and overall survivals reaching 50% to 70% in adults. Although Burkitt lymphoma cells are extremely chemosensitive, biologically targeted therapies should be developed because current treatment options are suboptimal for patients with poor prognostic features or in the setting of relapsed disease.     

Hyperphosphatemia and hypocalcemia accompanying rapid cell lysis in a patient with Burkitt's lymphoma and Burkitt cell leukemia

Hyperphosphatemia, hypocalcemia and acute oliguric renal failure resulting from uric acid nephropathy developed in a patient with Burkitt's lymphoma and Burkitt cell leukemia after effective chemotherapy. A review of other reported cases in which the patients had similar metabolic abnormalities is presented, and the pathophysiology is discussed. The clinical setting in which these metabolic developments are most likely to occur is defined, and an approach for their prevention and management is presented.     

Hypokalaemia and lactic acidosis in a patient with myelomonocytic leukemia

We report a patient with myelomonocytic leukaemia, persistent hypokalaemia and lactic acidosis. Cytotoxic chemotherapy induced a short remission with normalisation of the potassium concentration; death resulted from lactic acidosis. These two uncommon complications of leukaemia are discussed briefly.     

Chronic lymphocytic leukemia coexisting with chronic myelomonocytic leukemia.

A case with coexisting chronic lymphocytic leukemia (CLL) and chronic myelomonocytic leukemia (CMML) is described. A 74-year-old man with a typical B-CLL also showed sustained peripheral blood and bone marrow monocytosis. Typical myelodysplastic changes and monosomy 7 were also found. Cytographic and immunophenotypic analysis confirmed the presence of two distinct cell populations, i.e., lymphoid and monocytoid. Both malignancies presented an extraordinarily benign prognosis. It remains uncertain whether monocytosis was either the expression of a distinct myelomonocytic clone or the progeny of a B/monocytic bipotential precursor able to feed both leukemic phenotypes.     

Pericarditis revealing chronic myelomonocytic leukemia

We report the case of a 67-year-old man who developed pericarditis as the initial manifestation of myelomonocytic leukemia. Leukemic pneumonitis developed 4 months later and the patient later died.