Elderly patients with acute leukemia are considered poor candidates for aggressive antileukemic combination chemotherapy, and are therefore regarded by many clinicians as hopeless. Are such cases really hopeless? Although mild chemotherapy with low-dose cytosine-arabinoside (LDAC) has been recognized as beneficial for more than a decade, it is not often used in the elderly. 2 cases of leukemia which developed after a myeloblastic syndrome in men aged 71 and 84 years, respectively, are described. Both achieved complete remission for 18 and 13 months, respectively, following a course of LDAC. The literature also reveals that some elderly leukemic patients may benefit from this relatively nontoxic therapy.
In the internal medicine departments, hospitalization and treatment of ventilated patients is carried out in "enhanced treatment rooms".These rooms require professional and skilled nursing staff and round the clock supervision.These conditions are not always available in internal medicine departments that have a patient load beyond the inpatient beds, a chronic shortage of physicians and nurses, staff burnout and lack of professional prestige.
Intravascular large cell lymphoma (IVLL) is a rare neoplasm characterized by the proliferation of malignant lymphoid cells within the lumens of small to medium-sized blood vessels. The central nervous system, skin, and endocrine systems are most commonly involved. IVLL may disseminate to the heart, pancreas, liver, spleen, kidneys, and adrenal glands. We report a 52-year-old patient who was admitted for fever of unknown origin for 3 weeks, jaundice and abnormal liver function tests. Fever, high levels of bilirubin, severe anemia, thrombocytopenia, and a very fulminant course characterized the clinical picture. Although bone marrow involvement is quite rare, the diagnosis of IVLL in this patient was done by bone marrow biopsy. The patient was treated with CHOP protocol and received the first course but the aggressive disease led to the patient's death.
Warm autoimmune hemolytic anemia (AIHA) is a condition in which peripheral red blood cell (RBC) destruction is induced by the presence of an autoantibody. Pure red cell aplasia (PRCA) represents an isolated process of decreased erythropoiesis. The combination of both is quite rare, with a very poor prognosis. We describe a patient with isolated splenic lymphoma whose presentation was a combination of AIHA and PRCA. The patient was resistant to all treatment.Erythroid colony assays were performed, in order to compare the effect of the patient's serum on colonies with that of a normal control.The patient's serum significantly suppressed normal erythroid colony growth. A red cell eluate revealed the presence of a warm autoantibody.The patient's serum contained warm autoantibody responsible for peripheral RBC destruction and a humoral factor, perhaps the warm autoantibody, which suppressed bone marrow erythropoiesis. Establishing an early diagnosis, and treatment of the underlying disease might result in a better prognosis.
