Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

Acute Lymphoblastic Leukemia Acute Myeloblastic Leukemia 37

follow-up

Routine

■Response Assessment: Initial bone marrow aspiration and biopsy

must be obtained on day 29 of initial therapy to determine response.

If no remission, need to move quickly in assessing options for allo-

geneic stem cell transplantation; if positive response, need to con-

tinue with therapeutic plan.

■Surveillance Bone Marrows: Required every 6 months or sooner if

relapse is suspected based upon peripheral blood counts; opportu-

nity exists for following molecular probes for minimal residual dis-

ease for those in complete remission. Monitoring the bone marrow

for evidence of minimal residual disease appears to identify those

patients at higher risk for relapse. The bone marrow is the most com-

mon site for relapse in ALL.

complications and prognosis

■Long-term disease outcome: Current strategies have resulted in the

achievement of a complete remission in 70–90% of adults, with long-

term survival in the 25–50% range. Risk-based therapeutic strategies

have been attempted to reduce the short- and long-term toxicities

associated with the treatment of the disease. Highest risk of death

during therapy is related to infection. Long-term risks of disease

relate to relapse, which can occur for years after completion of treat-

ment. Extramedullary relapse can occur in the CNS, the skin, the

testes in males, and anywhere in the body.

■Late complications: Aggressive prophylactic treatment of the CNS

with irradiation and intrathecal chemotherapy may result in severe

neurologic toxicity, which has necessitated risk-based therapeutic

strategies; long-term complications of intensive chemotherapy may

produce end-organ damage in the long-term survivors of success-

ful chemotherapy; patients must be watched closely for evidence of

secondary malignancies and consequences of immunosuppression.

Acute Myeloblastic Leukemia............................

JAMES D. GRIFFIN, MD

history & physical

History

■Preleukemic syndrome, radiation, prior chemotherapy

■Family history of leukemia uncommon