No abstract

Cytarabine is an effective agent in the treatment of acute leukemia. Since its approval by The Food and Drug Administration in 1969, the clinical effectiveness of this drug has increased as knowledge of its pharmacologic and biologic properties has been translated into clinical trials. A complete remission rate of greater than 50% can be achieved when cytarabine is used in combination with other agents in the treatment of adult acute myeloblastic leukemia. Remissions occur only after the development of significant bone-marrow hypoplasia, and the care of patients through this period of pancytopenia requires elaborate supportive techniques and facilities. The role of cytarabine in the treatment of acute lymphoblastic leukemia and lymphoma is still under clinical investigation and appears promising. Because the clinical effectiveness of cytarabine in the treatment of nonmalignant diseases has not been proved, its use in these disorders must be considered investigational and weighed against the serious bone-marrow suppression and potential long-term hazards of this drug.

A patient with recurrent painful ecchymoses was presented with features similar to those described for patients with autoerythrocyte sensitization. This patient differed in that she was reactive to the red cell hemolysate and purified hemoglobin and not to red cell lipid, red cell stroma, or leukocyte DNA. No evidence was found to support the hypothesis that the abnormal vascular reaction involved an immunologic mechanism. The patient was observed forcibly inducing bruises but not manipulating the skin tests. It was concluded that a cutaneous hyperreactivity to hemoglobin in association with psychological disturbances was responsible for the painful ecchymoses in this patient.