Successful treatment of first and second recurrence of acute lymphoblastic leukemia after related allogeneic bone marrow transplant at unusual sites using single-dose vincristine followed by interferon-α2b and granulocyte-macrophage colony-stimulating factor

Abstract

Successful treatment of first and second recurrence of acute lymphoblastic leukemia after related allogeneic bone marrow transplant at unusual sites using single-dose vincristine followed by interferon-α2b and granulocyte-macrophage colony-stimulating factor,

18FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

“…PET/CT scans in three were negative for tumor but one had persistent marrow uptake after a fourth hyperCVAD course despite complete marrow response to the first . Two patients remained clinically well at 1 and 2 years , two had further tumors , and one had no follow‐up information . Two others patients, who did not have marrow relapse, received chemotherapy only; one died on treatment and the other is well over 4 years after second transplant .…”

“…The other 14 were found to have multiple extramedullary tumors and 12 were treated. All six with simultaneous marrow relapse received systemic chemotherapy and obtained marrow and clinical tumor responses . PET/CT scans in three were negative for tumor but one had persistent marrow uptake after a fourth hyperCVAD course despite complete marrow response to the first .…”

“…Another point brought to light in these cases is that when marrow is involved in patients with extramedullary tumors, only fewer than 30% marrow blasts may be seen . A low blast percentage in any patient could indicate metastatic invasion of the marrow from a resistant tumor that should be sought and treated.…”

Leukemia in gastrointestinal organs as cause of treatment failure: 378 cases analyzed

“…Involvement of more than one GI site was seen by regional radiology or PET scans in the majority . Only 3 had evidence of morphologic marrow relapse, one with only 10% blasts . Surgery was performed in only 4 cases, and 4 received only chemotherapy.…”

“…All sites resolved on PET/CT in 2 months after treatment with vincristine, interferon, and G‐CSF. A year later, isolated pericardial relapse was treated with the same regimen, and she continued well a year later …”