Man, Figure 51. Left: Immature myelocytic cells (many promyelocytes) in marrow of subject No. 54, 6 weeks before death. x 1650. Right: Promyelocytes with Auer rods were numerous. x 1650. During the 1972 annual examination the subject was found to have a WBC of 2000 and a platelet count of 120,000. He showednoothersignificantfindings and appeared to be a healthy and husky 19-year-old. He was brought to BNL, where a bone marrow examination revealed typical acute myelogencus leukemia, predominately of the pro- third molar, and a left chronic otitis media. Antileukemic medication included cytosine arabinoside, 6-thioguanine, heparin,oxacillin or cephalothin with gentamicin, and later ampicillin. He received blood and platelet transfusions, some from an older brother flown in from the Marshail Islands, but compatible platelets were not available. Plate- Figure 51). He was transferred to the National veloped signs of a hemorrhagic diathesis with marked hemithorax. He was placed in respirator, mvelocytic type with numerous Auer rods (see Cancer Institute at Bethesda, where examination resulted in few physical findings besides the bone marrow changes noted.* He had a slight inflammation of the pharynx, periodontitis around the right *Drs. Edward S. Henderson, James Mabry, Joan Bull, Maria Tomaszewsia, and Jacqueline Peng of the National Cancer Institute and Dr. Gundabhaktha Chikkapa of Brookhaven Natonal Laboratory assisted with this study. let levels continued low, and within 2 weeks he de- but his condition worsened, and he died 6 weeks after admission. (See Appendix 11 for hospital summary. ) The principal autopsy findings included acute myeloblastic (promyelocytic?) leukemia in spleen, lymph nodes, arachnoid, and bone marrow. There had been massive pulmonary hemorrhagebilaterally and inflammation ofthe parotid gland. It was Table 36 Difference in Mean Peripheral Blood Levels Between Subject With Leukemia (No. 54) and Exposed Peers WBC (x 10-3) Neut. (x 10-3) 1954 Exposed peers Leukemia case 77 5.7 (+ 26%) 4.1 2.5 (— 39%} 1955-72 Exposed peers Leukemia case 8.. 6.5 (—21%) 3.8 2.7 (—30%) Lymph. (1073) Plate. ( x 10-3) Het., % 3.0 2.8 (-6%) 246 187 (~24%) 37.3 36.4 ( -—2.5%) 3.5 3.1 (-11%) 293 271 (-7.5%) 39.2 40.5 (+37)