mercaptopurine and Mediastinal-Neoplasms

We describe a 45-year-old female who developed acute myelogenous leukemia (AML) associated with a mediastinal mass. The patient achieved a complete remission accompanied by resolution of the mediastinal mass following intensive chemotherapy alone. A review of the literature disclosed ten AML patients with a mediastinal tumor; all five patients who had mediastinal granulocytic sarcoma treated by local irradiation prior to developing AML, eventually relapsed as frank leukemia and died soon afterwards. On the other hand, three of the other five patients who simultaneously developed both a mediastinal tumor and overt AML achieved complete remission with combination chemotherapy. In conclusion, intensive chemotherapy should be considered for a patient with granulocytic sarcoma of the mediastinum, irrespective of the concomitant leukemia.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Female; Follow-Up Studies; Humans; Leukapheresis; Leukemia, Myeloid, Acute; Mediastinal Neoplasms; Mercaptopurine; Middle Aged; Prednisolone; Radiography, Thoracic; Remission Induction; Time Factors; Tomography, X-Ray Computed

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Arabinonucleosides; Disease Progression; Fatal Outcome; Humans; Injections, Spinal; Male; Mediastinal Neoplasms; Mercaptopurine; Methotrexate; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Quadriplegia; Spinal Cord; Spinal Cord Diseases

True histiocytic lymphomas (THLs) are rare tumors in which the malignant cells show morphologic and immunophenotypic evidence of histiocytic differentiation. We describe THLs that arose after therapy for one case of T-lineage lymphoblastic lymphoma (LyL) and two cases of acute lymphoblastic leukemia (ALL) (both CD10+, one pre-B phenotype). The lymphoblastic neoplasms were not unusual in any way, and responded well to standard therapy. The THLs arose 10 to 20 months after complete remission was achieved for the lymphoblastic neoplasms, at which time there was still no clinical or pathologic evidence of the lymphoblastic neoplasms. All three THLs exhibited clinical and morphologic features of malignancy. Neoplastic cells in the THLs had abundant eosinophilic vacuolated cytoplasm and pleomorphic nuclei, and expressed histiocytic antigens in the absence of lymphocyte-specific lineage markers. Because THLs are rare neoplasms, their occurrence after otherwise successful therapy for lymphoblastic neoplasms in these three cases may constitute a distinct clinicopathologic entity.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Bone Neoplasms; Child; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Daunorubicin; Etoposide; Fatal Outcome; Humans; Ifosfamide; Lymphoma, Large B-Cell, Diffuse; Male; Mediastinal Neoplasms; Mercaptopurine; Methotrexate; Methylprednisolone; Neoplasms, Second Primary; Neoplastic Stem Cells; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Prednisone; Remission Induction; Scapula; Spinal Neoplasms; Vincristine

Fourteen children with mediastinal lymphoblastic lymphoma (MLL) were treated with the six-drug APO protocol. This regimen includes aggressive intermittent chemotherapy and prophylactic central nervous system therapy. Mediastinal irradiation was given only for emergency relief of mediastinal compression (two children) or for incomplete resolution of mediastinal widening with chemotherapy (one child). All 14 patients achieved complete remission; only 1 has relapsed. Toxicities were not severe. APO is effective therapy for children with MLL. APO should receive further trials in children and adults with T-cell lymphoblastic lymphomas.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Child; Child, Preschool; Doxorubicin; Female; Humans; Lymphoma, Non-Hodgkin; Male; Mediastinal Neoplasms; Mercaptopurine; Methotrexate; Prednisone; Vincristine

Topics: Adolescent; Child; Child, Preschool; Cobalt Isotopes; Cyclophosphamide; Head and Neck Neoplasms; Humans; Leukemia; Lymphoma, Non-Hodgkin; Mediastinal Neoplasms; Mercaptopurine; Methotrexate; Peritoneal Neoplasms; Prednisone; Radioisotope Teletherapy; Remission, Spontaneous; Time Factors; Vincristine