A rare case of leukemia cutis in T-cell acute lymphoblastic leukemia (T-ALL) in an elderly patient
Keywords:
T cell, Acute lymphoblastic leukemia, Leukemia cutis, Hepato-splenomegaly
Abstract
Primary cutaneous involvement in T-cell acute lymphoblastic leukemia (ALL) is rare in elderly patients. Here we present a case of 65 years old male admitted to a metropolitan tertiary care hospital because of maculo-papular lesions on chest and back for last 3 months as chief complaint along with on and off history of fever, fatigability and anorexia. On general examination, there was no lymphadenopathy. Per-abdomen examination revealed hepato-splenomegaly. CT scan of chest and abdomen showed para-tracheal, pre-tracheal, carinal, hilar and abdominal lymphadenopathy. Peripheral blood smear and bone marrow aspiration showed more than 80% of lymphoblasts. Flow cytometry of the bone marrow aspirate showed CD7, CD5, CD45 and TdT positivity indicating T–cell origin. Skin biopsy from maculo-papular lesion revealed secondary leukemic infiltration of the skin. Corroborating all the above findings, a final diagnosis of T-cell ALL with leukemia cutis was made. Thereafter patient was given chemotherapy and after one month, the skin lesions started resolving and total leukocyte count (TLC) decreased. One week later, skin lesions relapsed with fall in hemoglobin and rise in TLC. Repeat bone marrow aspirate showed 90% blasts cells. Then, patient was put on palliative therapy but his condition progressively deteriorated and ultimately died within four months of diagnosis.References
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25. Thomas X, Thiebaut A, Olteanu N, Danaïla C, Charrin C, Archimbaud E. Philadelphia chromosome positive adult acute lymphoblastic leukemia: characteristics, prognostic factors and treatment outcome. Hematol Cell Ther1998; 40(3):119–28.
26. Taylor PRA, Reid MM, Bown N, Hamilton PJ, Proctor SJ. Acute lymphoblastic leukemia in patients aged 60 years and over: a population-based study of incidence and outcome. Blood 1992; 80(7): 1813-17.
27. Kantarjian HM, O'Brien S, Smith TL, Cortes J, Giles FJ, Beran M, Pierce Set al. Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia. J ClinOncol2000; 18 (3): 547-61.
2. Shin DY, Kim I, Kim KH, Choi Y, Beom SH, Yang Y, Acute Lymphoblastic Leukemia in Elderly Patients: A Single Institution's Experience. Korean J Intern med 2011; 26(3): 328-39.
3. Bathia S, Robinson L. Epidemiology of leukemia in childhood. In: Nathan DG, Orkin SH, Ginsburg D, Look AT, editors. Nathan and Oski's Hematology of Infancy and childhood. 6th ed. Philadelphia: Saunders; 2003.p.1081–1100.
4. Weedon D. Cutaneous infiltrates- lymphomatous and leukemic. In: Weedon D, Strutton G, editors. Skin Pathology. 2nd ed. New York: Churchill Livingstone; 2002.p.1118-20.
5. Agis H, Weltermann A, Fonatsch C, Haas O, Mitterbauer G, Müllauer L, et al.A comparative study on demographic, haematological, and cytogenetic findings and prognosis in acute myeloid leukemia with and without leukemia cutis. Ann Hematol 2002; 81(2):90-95.
6. Yen A, Sanchez R, Oblender M, Raimer S. Leukemia cutis: Darier’s sign in a neonate with acute lymphoblastic leukemia. J Am Acad Dermatol 1996; 34(2): 375-78.
7. Pui CH. Acute lymphoblastic lymphoma. In: BeutlerE, CollerB, LitchmanM, Kipps TJ, editors. Williams hematology. 6thed. New York: Graw-Hill; 2001.p.1141-62.
8. Annino L, Vegna LM, Camera A, Specchia G, Visani Gand Fioritoni G. Treatment of adult acute lymphoblasticleukemia (ALL): long-term follow-up of the GIMEMA ALL 0288 randomized study. Blood 2002; 99(3): 863-71.
9. Cho-Vega JH, Medeiros LJ, Prieto VG, Vega F. Leukemia cutis. Am J Clin Pathol 2008; 129(1):130-42.
10. Murphy MJ. Leukemia cutis. In: Murphy MJ, editor. Molecular diagnostics in dermatology & dermatopathology.1sted.New York: Springer; 2011.p.263-81.
11. Sander CA, Medeiros LJ, Abruzzo LV, Horak ID, Jaffe ES. Lymphoblastic lymphoma presenting in cutaneous sites: A clinicopathologic analysis of six cases. J Am Acad Dermatol 1991; 25(6 Pt. 1):1023-31.
12. Ali R, Ozan U, Ozkalemkas F,Ozcelik T, Ozkocaman V, Ozturk H, Tunali S et al. Leukaemia cutis in T-cell acute lymphoblastic leukaemia. Cytopathology 2006; 17(3):158-61.
13. Su WP, Buechner SA, Li CY. Clinicopathologic correlations in leukemia cutis. J Am Acad Dermatol 1984; 11(1):121-8.
14. Marti RM, Pujol RM, Servitje O, Palou J, Romagosa V, BordesR, et al. Sézary syndrome and related variants of classic cutaneous T-cell lymphoma: A descriptive and prognostic clinicopathologic study of 29 cases. Leuk Lymphoma 2003; 44(1):59-69.
15. Reiter A, Schrappe M, Ludwig WD, Hiddemann W, Sauter S, Henze G,et al. Chemotherapy in 998 unselected childhood acute lymphoblastic leukemia patients. Results and conclusion of multicentre trial ALL-BFM 86. Blood 1994; 84(9):3122-33.
16. Chessells JM, Hall E, Prentice HG, Durrant J, Bailey CC, Richards SM: The impact of age on outcome in lymphoblastic leukemia; MRC UKALL X and XA compared: A report from the MRC Paediatric and Adult Working Parties. Leukemia 1998; 12(4):463-73.
17. Thomas X, Olteanu N, Charrin C, Lhéritier V, Magaud JP, Fiere D. Acute lymphoblastic leukemia in the elderly: The Edouard Herriot Hospital experience. Am J Hematol 2001; 67(2):73-83.
18. Petersdorf SH, Kopecky KJ, Head DR, Boldt DH, Balcerzak SP, Wun T. Comparison of L10M consolidation regimen to an alternative regimen including escalating methotrexate/L-asperginase for adult acute lymphoblastic leukaemia : A southwest Oncology Group Study; Leukaemia 2001;15(2):208-16.
19. Thomas DA, Cortes J, O Brien S, Pierce S, Faderl S, Albitar M, Hagemeister FB et al. Hyper-CVAD program in Burkitt’s-type adult acute lymphoblastic leukemia. J ClinOncol1999; 17 (8): 2461-70.
20. LazarusHM, RichardsSM, Chopra R, LitzowMR,Burnett AK, Wiernik PH. Central nervous system involvement in adults in adult acute lymphoblastic leukemia at diagnosis: results from the international ALL trial MRC UKALL XII/ECOG E2993. Blood 2006; 108(2):465-72.
21. Arora RS, Eden TOB, Kapoor G. Epidemiology of childhood cancer in India. Indian J Cancer 2009; 46(4):264-73.
22. Delannoy A, Sebban C, Cony-MakhoulP,Cazin B,Cordonnier C,Bouabdallah R. French Group for Treatment of Adult Acute Lymphoblastic Leukemia. Age-adapted induction treatment of acute lymphoblastic leukemia in the elderly and assessment of maintenance with interferon combined with chemotherapy: a multicentric prospective study in forty patients. Leukemia 1997; 11(9):1429–34.
23. Annino L, Goekbuget N,Delannoy A. Acute lymphoblastic leukemia in the elderly. The Hematology Journal 2002; 3: 219-23.
24. Larson RA. Acute lymphoblastic leukemia: older patients and newer drugs.Hematology Am Soc Hematol Educ Program 2005:131–136.
25. Thomas X, Thiebaut A, Olteanu N, Danaïla C, Charrin C, Archimbaud E. Philadelphia chromosome positive adult acute lymphoblastic leukemia: characteristics, prognostic factors and treatment outcome. Hematol Cell Ther1998; 40(3):119–28.
26. Taylor PRA, Reid MM, Bown N, Hamilton PJ, Proctor SJ. Acute lymphoblastic leukemia in patients aged 60 years and over: a population-based study of incidence and outcome. Blood 1992; 80(7): 1813-17.
27. Kantarjian HM, O'Brien S, Smith TL, Cortes J, Giles FJ, Beran M, Pierce Set al. Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia. J ClinOncol2000; 18 (3): 547-61.
Published
2016-10-03
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