levoleucovorin and Leukocytosis

Ataxia-telangiectasia (AT) is a hereditary disorder characterized by progressive neurological dysfunction, oculocutaneous telangiectasia, immunodeficiency, cancer susceptibility, and radiation sensitivity. Pediatric patients may develop acute lymphoblastic leukemia (ALL). However development of ALL in an adult patient with AT is a rare occurrence. Here we report such a patient who presented with hyperleukocytosis and were treated with leukapheresis. A 25years old male patient, who were diagnosed with AT and mental retardation, was admitted to the emergency department due to fatigue, nausea and headache. On admission he had a moderate general condition and was fully cooperated. His white blood cell (WBC) count were 466×10(9)/l. Blastic cells were observed in peripheral blood smear. Flow cytometry (FC) of peripheral blood showed T-ALL. Two sessions of large volume leukapheresis was performed. Symptoms due to hyperleukocytosis markedly improved after leukapheresis. Patients with AT should be closely monitored due to risk of malignancy. Leukapheresis may improve the prognosis of high risk ALL patients presenting with hyperleukocytosis.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Ataxia Telangiectasia; Doxorubicin; Flow Cytometry; Humans; Leucovorin; Leukapheresis; Leukocytosis; Male; Methotrexate; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prognosis; Steroids; Vincristine

The extent to which neoadjuvant chemoradiotherapy for rectal cancer influences postoperative morbidity is controversial. This study investigated whether this treatment suppresses the normal perioperative inflammatory response and explored the clinical implications.. Prospective databases were queried to identify 37 consecutive study patients undergoing definitive surgery following 5-FU/capecitabine-based chemoradiotherapy and 34 consecutive untreated control patients operated upon for rectal or rectosigmoid cancer. Preoperative (< 10 days) and postoperative (< 24 h) neutrophil counts, along with morbidity data, were confirmed retrospectively. Univariate and multivariate analyses assessed the apparent effect of chemoradiotherapy on change in neutrophil count. The latter's association with postoperative morbidity was then examined.. Sufficient data were available for 34 study and 27 control patients. Repeated-measures ANCOVA revealed significant differences between their perioperative neutrophil counts (P = 0.02). Of the other characteristics which differed between the groups, only age and tumour location were prognostically significant regarding perioperative change in neutrophil count. Accounting for relevant covariates, chemoradiotherapy was significantly associated with a suppressed perioperative neutrophil leucocytosis. Local postoperative complications affected 25 of 61 patients, who had lower perioperative neutrophil increases than their counterparts (P = 0.016).. Chemoradiotherapy appears to suppress the perioperative inflammatory response, thereby increasing susceptibility to local postoperative complications.

Topics: Aged; Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Fluorouracil; Humans; Leucovorin; Leukocytosis; Male; Middle Aged; Morbidity; Neoadjuvant Therapy; Neutrophils; Postoperative Complications; Radiotherapy, Adjuvant; Rectal Neoplasms; Treatment Outcome; Vitamin B Complex

Two cases of non-Hodgkin's lymphoma suffered from acute respiratory failure. Both patients were treated with MACOP-B therapy, and received recombinant granulocyte-colony stimulating factor (rG-CSF) during the myelosuppression. They had fever and severe hypoxemia several days after 11 and 12-week's treatment, respectively. The chest X-ray films revealed diffuse fine granular shadows in bilateral lung fields. The number of white blood cells had rapidly increased when the shadows appeared. These cases suggested the possibility that rG-CSF, or the rapid increase of white blood cells, might induce interstitial pneumonia.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Doxorubicin; Granulocyte Colony-Stimulating Factor; Humans; Leucovorin; Leukocytosis; Lymphoma, Large B-Cell, Diffuse; Male; Methotrexate; Middle Aged; Prednisone; Pulmonary Fibrosis; Recombinant Proteins; Vincristine