- Ist - Admitted on 10-2-72 to National Cancer Institute, Hematology and Supportive Care Branch Expired on 11-15-72 from National Cancer Institute, Hematology and Supportive Care Branch HOSPITAL COURSE: Problem No, 1 - Acute Proganulocytic Leukemia: On the morning of the second hospital day che patient had a posterior iliac crest bone marrow aspirate revealing decreased normal marrow elements and infiltration by cells with prominent eosinophilic cytoplasmic granules and prominent nucleoli. Some of these cells had Auer rods in the cytoplasm. The impression was that the marrow showed changes of acute promyelocytic leukemia. A bone marrow biopsy showed hypercellularity and infiltration by abnormal cells. Despite extensive marrow involvement, however, the patient did not have severe anemia or circulating abnormal cells when he first presented closely in che special lhmbtlacoty ‘thre c1 fot > Xe plan was to treat him for bleeding episodes, the appearatide of blast cells if the perii@étal tBitod, Splenomegaly, or ; deterioration of coaguPation pafameters. £°€6 S*7st vote Unfortunately, $iter ont L°osT 9° €é fe:"28 days ig.$50 oucpaels atc oF 9 /€ . ; z aic,cihe patient's plagelec a count fell to 7,000,oaqd he d oped an gaggche araithd a e fever. He wasgt 9 . therefore readmittedgarg] on October 15 begoee,on thecapy whithycytosine arabinoside, 200 mgIT per meter squared intr¥venouslySévery 12 BOOte, and ‘S*thidgdanine 790 mg. per mater’? squared orally everyS12 hours. °The reeBabe base+t ee 3 plastin time, thromb¥h. eime, £1 ogen, Fiftin sp *hrody ts, big’time, partial factor VIII wer oT 0-8 ‘ within the normal raggq; nevertheless, beqayse of Staage: tiongef intravascular gpagulgtion with acute progrgmlocyticojeukemia, shegwas tueaged arephylaecically with hepaodin, 3 0.5 mg. per kg. intravenously every 6 hours for firstfive days of chemorherapeutic drugs. On the first day of treatment the white STPGR!cOie Gas 1,700 with 21% neutrophils, . 56% lymphocytes att 30%aye precursors; platelets were 32,000 (after transfusion) Te eee at and hemoglobin 10.3. ite count remained low throughout the remainder of his hos- ital course; abnorma),foung disgppeaged from the peripheral blood on the ninth day of treatment; platelet §54gs fusions,were o ered yee days in an effort to keep the platelet ,gount abque,720, 000. 1 bone Erte aki ations revealed :ton, zt day five, hypercelluker; marrow witb 80% oknertal cont daaor: pn: seyen, Mypwfiroeldantyrg «sc. marrow with 90% progwdnnlocytersson day twette, hyyestelDutaae with 95% progtanulost cytes; on day fourtedd, 'hyperdéllular mackie iich n day ninetéen, ‘ST normecellular marrow h 80% remo Say cr,t rece after twe ~twe days of treatment, a ell T erat normal prouyelocytes. 4, | Qn the day prior to th the pettent's.kh obin gmag,3. Sattatell count, 2,100,with ,7-: 100% lymphocytes, andcpiatelet equnt 11,000z+1 He hast zpacesred 10 waits of packed redz 91 blood cells and had Gécalved platéler traitd £60tons 0/18 aden +4 of Ris hospital stay.?7 oT | During the last two of. %{£6 he oeHA ve Yatelet count aftét tt platelet: transfusiong,. robably (facause Hi transfusion. Rongelap (54) 7 °6o°T 7 90ST BIZ 0 og g9T Ci'T O9aih Ad 3 “ett:- - cot ve 1961 reich jinedges fe not available Sor $°SsTt 0°6FT €°oLt Soe O° 29T §=orce 6°6S.- T'S9T £949 o°estT €°Lé FUsATE ‘an kpog 84/T9u °F 5u 52 ey o7sot z _@ _prsswaod ‘-oRn 24 . of “eo 7 6% zy oo 09 of e? o£ ST sé T Cheat kecoeD Cl] _Wesery Prysical Eseninetion 8G, Semmey 34 Tue CLINICAL CENTER CD Conwiteien CD tetewve, CD Centicmation NANG UNSPTYETOF feeb UdeaZojI2eds wamE) (panuytjues) ZT Xppueddy - 143 - ? qoeppative uo SYIVON Niners (Rew, S73) “on a2efqns