During the neutropenic phase, leukemia patients receiving chemotherapy are prone to bacterial and, fungal infections; occasionally mycobacterial, viral and protozoal organisms may also cause infections. Mycobacterium tuberculosis infection was reported very rarely in these patients. This report describes four patients with M. tuberculosis infection identified from 185 adult patients who were diagnosed myelogenous leukemia between January 2003, and December 2004. There was no patient with M. tuberculosis infection from 44 lymphoid leukemia and 11 acute biphenotypic leukemia patients. Sites of infection were all lymph nodes. Three among four patients were presented with lymphadenopathy at initial diagnosis of leukemia, and the other one presented with lymphadenopathy after induction chemotherapy. There was no patient presented with lymphadenopathy during the neutropenic phase. Tuberculous lymphadenitis was presented in a patient with three acute myelogenous leukemia (FAB class 2 M4, 1 M2) and a chronic myelogenous leukemia, accelerated phase. An acute myelogenous leukemia patient had a leukemic cell and tubercle bacilli in the same lymph node. Tuberculosis should also be included as a differential diagnosis in myelogenous leukemia patient with lymphadenopathy, especially in the countries in which the disease is endemic.
Adult ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Humans ; Induction Chemotherapy ; Leukemia ; Leukemia, Biphenotypic, Acute ; Leukemia, Lymphoid ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid* ; Leukemia, Myeloid, Acute ; Lymph Nodes ; Lymphatic Diseases ; Mycobacterium tuberculosis ; Tuberculosis ; Tuberculosis, Lymph Node*

During the neutropenic phase, leukemia patients receiving chemotherapy are prone to bacterial and, fungal infections; occasionally mycobacterial, viral and protozoal organisms may also cause infections. Mycobacterium tuberculosis infection was reported very rarely in these patients. This report describes four patients with M. tuberculosis infection identified from 185 adult patients who were diagnosed myelogenous leukemia between January 2003, and December 2004. There was no patient with M. tuberculosis infection from 44 lymphoid leukemia and 11 acute biphenotypic leukemia patients. Sites of infection were all lymph nodes. Three among four patients were presented with lymphadenopathy at initial diagnosis of leukemia, and the other one presented with lymphadenopathy after induction chemotherapy. There was no patient presented with lymphadenopathy during the neutropenic phase. Tuberculous lymphadenitis was presented in a patient with three acute myelogenous leukemia (FAB class 2 M4, 1 M2) and a chronic myelogenous leukemia, accelerated phase. An acute myelogenous leukemia patient had a leukemic cell and tubercle bacilli in the same lymph node. Tuberculosis should also be included as a differential diagnosis in myelogenous leukemia patient with lymphadenopathy, especially in the countries in which the disease is endemic.
Adult ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Humans ; Induction Chemotherapy ; Leukemia ; Leukemia, Biphenotypic, Acute ; Leukemia, Lymphoid ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid* ; Leukemia, Myeloid, Acute ; Lymph Nodes ; Lymphatic Diseases ; Mycobacterium tuberculosis ; Tuberculosis ; Tuberculosis, Lymph Node*

BACKGROUND: Cellular drug resistance is supposed to play a major role in chemotherapy failure or relapse. The purpose of this study was to analyze the relationship between in vitro chemosensitivity test results using a 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and clinical response on chemotherapy, and to find the possibility of optimizing the treatment protocol for individual patients according to their actual drug resistance. METHODS: For MTT assay, we obtained bone marrow aspirates from 103 patients with acute leukemia at the time of initial diagnosis or relapse. The following drugs were tested: cytarabine, vincristine, methotrexate, daunorubicin, dexamethasone, L-asparaginase, and mitoxantrone. To evaluate clinical responses after induction chemotherapy, we followed up on their bone marrow study. RESULTS: In our study, in vitro chemosensitivity test with the MTT assay significantly predicted whether patients with AML remained continuous complete remission or went into relapse. It also predicted whether or not child patients with ALL would acquire complete remission after induction chemotherapy. CONCLUSIONS: Although it does not provide the insight into the mechanisms that cause drug resistance, the MTT assay may be a useful tool in individually optimizing the chemotherapy of patients with acute leukemia.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibiotics, Antineoplastic/therapeutic use ; Child ; Child, Preschool ; Coloring Agents ; Cytarabine/therapeutic use ; Daunorubicin/therapeutic use ; Drug Evaluation, Preclinical ; Drug Resistance, Neoplasm ; Female ; Humans ; Infant ; Leukemia, Biphenotypic, Acute/diagnosis/*drug therapy ; Leukemia, Myeloid, Acute/diagnosis/*drug therapy ; Male ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis/*drug therapy ; Tetrazolium Salts ; Thiazoles ; Treatment Outcome

In acute leukemia, leukemic infiltration of the breast is extremely rare. We report a case of biphenotypic acute leukemia (BAL) that presented as a breast mass. A 30-year-old woman presented with a 4-month history of a right breast mass with nipple discharge and easy fatigue. She had received chemotherapy and peripheral blood stem cell transplantation for BAL and had been in complete remission for the last 2 years. Core needle biopsy of the breast mass revealed monomorphous infiltrates of blast cells with round nuclei and fine chromatin, consistent with leukemic infiltration. Subsequent bone marrow biopsy showed diffuse infiltration of immature cells. However, bone marrow karyotyping showed 46, XY, suggesting complete engraftment of transplanted donor cells. This is the report of BAL recurring as a breast mass. In the differential diagnosis of a breast mass, extramedullary relapse should be considered when the patient has a history of leukemia.
Adult ; Biopsy ; Biopsy, Large-Core Needle ; Bone Marrow ; Breast* ; Chromatin ; Diagnosis, Differential ; Drug Therapy ; Fatigue ; Female ; Humans ; Karyotyping ; Leukemia ; Leukemia, Biphenotypic, Acute* ; Leukemic Infiltration ; Nipples ; Peripheral Blood Stem Cell Transplantation ; Recurrence* ; Tissue Donors