Download: Natural History and Diagnostic Peculiarities of Acute Leukemia

… as the initial sign of the disease.9 Under these circumstances, small infants may … This description of the presenting signs and symptoms in acute leukemia is far from complete, but it …DOI: 10.3322/canjclin.14.5.204 1964;14;204-209 CA Cancer J Clin Carl V. Moore Natural History and Diagnostic Peculiarities of Acute Leukemia This information is current as of December 11, 2010 http://caonline. amcancersoc.org the World Wide Web at: The online version of this article, along with updated information and services, is located on http: …

Onset of Acute Leukemia Brief mention should be made hereof those signs and symptoms which appear when the disease first develops. The effects are produced by three mechanisms: (1) Leukemic proliferation in the bone marrow, which may produce anemia, throm bocytopenia, and a deficiency of normally functioning leukocytes. Consequently, weak ness and pallor from the anemia, hemorrhage into any tissue or from mucous membranes, and susceptll)ilitytoinfection may result. (2) Infiltration and proliferation of leu kemiccellsin various organs and tissues. (3) Metabolic alterations, which are poorly understood and not always clearly re lated to cytopenias or infiltration, such as fever, fatigue, and irritability. It is evident from these generalconsidera. tionsthatevery organ or tissue maybe in@ volved, that the clinical manifestations of acute leukemia maybe extremely varied, and that the disease may first make itself known to the patient in many different ways. Symptoms often appear abruptly, particu. larlyinchildren. Not infrequently, however, the onset is more gradual, the patient becoming aware during the course of several months of progressive weakness, anorexia, pallor, and low-grade fever. With surprising frequency, the patient traces his awareness of ill health to an upper respiratoryinfec tion: instead of rapid recovery, the sense of prostration increases and other symptoms… Duration of the Disease The natural history of acute leukemia in terms of tile duration of the untreated dis ease is difficult to define, yet this information is important as a yardstick against which tile effectiveness of therapy must be measured. The difficulties are these: (1) The onset, as has been emphasized, is often hard to pinpoint. The leukemic proc ess obviously begins before manifestations appear. When tile l)atientgivesa history of systemic symptoms such as fatigue. irritabil it). or low-grade fever, he may not accurately remember when the symptoms first became noticeable, an(lone cannot be sure that they were caused by tile leukemia perse. Yet estimates of tile time between onset ofsymp toms and death give a clearer estimate of the total duration of the disease than do meas urementsfrom diagnosis or tile l)eginningof therapy to death. (2) During the last 15 years, most pa tientswithacute leukemia have been treated with one or more chemotherapeutic agents. One must therefore dig deeper into the past to obtain therapeutically unaltered estimates of survival. (3) Even when nochemotherai@eutic agents are utilized in the appraised cases, pa tientshaveI)eentreatedwith transfusions and antibiotics which in many instances have certainly prolonged the clinical course. Two sets of figures will be cited, neither describinga significant difference in prog nosisbetween children and adults having acute leukemia of any cell type. In ananaly sis of 751reported patients with acute leu kemianotgiven antileukemic chemotherapy, Tiveyfoundtile medium survival from onset to death to be about three months.’1 Ina Fig. 3. Ulceration of palate and pharynx ina woman with acute myelocytic leukemia, Note the dirty gray membrane. Lesion may occur in any of the forms of acute leukemia and resembles the oral lesion often seen inagranulocytic angina. review of the literature, he also summarized data on survival time among 218 children (Fig. 4).b0 Here, death occurred from\%-ithin just a few days to 16 months after onset. It can be noted that in tllis group 50 Pt”cent of tile cllildrell had (lied by the fourth month. Values reported from Dr. Wintrobeslabora tory (Fig. 5) are similar. When an attenipt was made to discover factors of prognostic significance, the follow. ingfactors pointed to relatively short sur vival: White l)loodcellcounts above 100.000 cu. mm., with a iligh percentage ofl)last forms; the presence of sternal tenderness; and hemorrhage severe eflougilto necessitate transfusion at the time of initialexamina tion.3 Inthedaysbefore antibiotics were available, infection was also of particular importance in shortening the disease. Most clinicians with extensive experience in the management of acute leukemia have….

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