Acute lymphoblastic leukemia

The patient feels sick from October 2002, i.e. the time of appearance of subfebrile temperature, pain in the right shoulder, feeling of heaviness in the left hypochondrium, general weakness. On examination, changes were revealed in blood counts. Upon consultation by hematologist, the patient was examined and treated for 9 days at the Department of Hematology of the Regional Hospital, and then he was transferred with the diagnosis of acute lymphoblastic leukosis, to the Clinic for Hematology of the Research Institute for Hematology and Blood transfusion with the diagnosis of acute lymphoblastic leukemia.

On admittance: pale and clean skin and mucosa, enlarged postercervical (up to 1x1 cm) and submaxillary (up to 2.0x1.0 cm) lymph nodes; other lymph nodes normal. Pulse rate is 100 beats/min, rhythmic. Cardiac sounds are clear, with correct melody of cardiac activity. Vesicular respiration. The abdomen is soft and painless on palpation. Bowel parts normal. Liver and spleen are not enlarged.

Total blood count and the myelograms are given in Tables 1 and 2.
The following treatment was prescribed: 2 mg onkovin intravenously (administered twice); 7.5 mg carminamycin intravenously (administered twice), daily 50 mg mercaptopurine and 60 mg prednisolone. Symptomatic therapy included metacin, vikalin, asparcam.

After 8 days, patient developed profound pancytopenia (Table 1). His condition was assessed as critical: acute weakness, palpitation, dyspnea on insignificant loads. Hematopoietic cells of human fetal liver were transplanted intravenously: sample E-325-K, embryo age 8 weeks; cells count 20x10⁶/ml; volume of administered suspension 1.5 ml; CFU-GM, 23.2x10³. The volume of transplanted cells amounted to 40% of the total mass of this sample stored in cryobank.

The patient tolerated transplantation well; no reactions were reported during transplantation. Syndrome of early posttransplantation improvement of general condition was not expressed. By the 5th day, the patient demonstrated decreasing weakness, improved general condition, and increased amount of motions. On 11th day, indices of peripheral blood cell composition were normalized. On the 20th day, a course of cytostatic therapy was started: onkovin, L-asparaginase, prednisolone; this course was completed when clinical and hematological remission developed; condition of the patient during the treatment was good.

Bone marrow indices: patient M., suffering from acute lymphoblastic leukosis
Transplantation: December 1, 2002

Indices	17.11.2002	21.01.2003	10.03.2003
Amount of megakaryocytes/mm	0	50	0
Amount of myelokaryocytes/mm	decreased cell amount	62,650	13,750
Blasts	85	3.5	4
Promyelocytes: neutrophilic	0	2.5	1
Myelocytes: neutrophilic eosinophilic	0.5	7.5	6 1
Metamyelocytes: neutrophilic eosinophilic		10	5 1
Stab: neutrophilic eosinophilic	1	12	9
Segmented: neutrophilic eosinophilic basophilic	0.5 0.5	15 0 1	23 2 1
Monocytes	2	2.5	4
Lymphocytes	7	6	8
Plasmatic cells			1
Pronormocytes		1.5	1
Normocytes: basophilic polyoxyphilic oxyphilic	0.5 3	5 4 29	5 1 20
Luko-erythroid ratio	21:1	1.5:1	3:1
Maturation index of erythroblasts	1	0.83	0.8
Bone marrow index of neutrophils		0.71	0.4

Blood indices in 17 years old patient M. suffering from acute leukemia

Date	Erythrocytes, 1012/l	Hemoglobin, g/l	Leukocytes, 109/l	Thrombocytes, 109/l	ESR, mm/h	Erythrocytes with fetal Hb, %
16.11.02	3.8	128	4.2	41	23	—
17.11.02	3.7	96	2.6	93	48	—
26.11.02	2.3	62	0.4	20	64	—
01.12.02	Cell Transplantation
03.12.02	2.8	75	1.3	78	44	0.03
07.12.02	3.1	90	2.6	135	13	0.12
08.12.02	2.4	80	4.0	—	13	0.30
10.12.02	4.4	112	3.6	220	12	0.42
17.12.02	4.3	128	10.2	344	4	0.36
04.01.03	4.3	128	7.0	262	2	0.40
15.03.03	5.1	112	4.9	330	10	0.40