Vnitr Lek 2017, 63(5):348-353 | DOI: 10.36290/vnl.2017.070

Acute lymphoblastic leukemia of adults - a case of prolonged hip pain diagnostics with a surprising conclusion: case report

Štěpán Hrabovský1,*, František Folber1, Barbora Jurová2, Zdeněk Řehák3, Michael Doubek1,4
1 Interní hematologická a onkologická klinika LF MU a FN Brno, pracoviště Bohunice
2 Klinika radiologie a nukleární medicíny LF MU a FN Brno, pracoviště Bohunice
3 Oddělení nukleární medicíny, PET centrum, RECAMO, MOÚ, Brno
4 Středoevropský technologický institut (CEITEC), Brno

Though acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood age, it is a rare diagnosis in adults. This disease often manifests with common and nonspecific symptoms, so it can easily escape an early diagnostics without a proper blood count examination. We present a case of an adult ALL patient suffering only from severe hips and thighs pain, without any significant blood count abnormities leading to the diagnostics. In the second part of the article, we summarize current highlights regarding this disease.

Keywords: acute lymphoblastic leukemia; adult; biological treatment; bone pain; CAR T-cells; osteolysis; symptoms

Received: April 5, 2017; Accepted: May 22, 2017; Published: May 1, 2017  Show citation

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Hrabovský Š, Folber F, Jurová B, Řehák Z, Doubek M. Acute lymphoblastic leukemia of adults - a case of prolonged hip pain diagnostics with a surprising conclusion: case report. Vnitr Lek. 2017;63(5):348-353. doi: 10.36290/vnl.2017.070.
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    References

    1. Hann IM, Gupta S, Palmer MK et al. The prognostic significance of radiological and symptomatic bone involvement in childhood acute lymphoblastic leukaemia. Med Pediatr Oncol 1979; 6(1): 51-55. Go to original source... Go to PubMed...
    2. Ribeiro RC, Pui CH, Schell MJ. Vertebral compression fracture as a presenting feature of acute lymphoblastic leukemia in children. Cancer 1988; 61(3): 589-592. Go to original source...
    3. Jonsson OG, Sartain P, Ducore JM et al. Bone pain as an initial symptom of childhood acute lymphoblastic leukemia: association with nearly normal hematologic indexes. J Pediatr 1990; 117(2 Pt 1): 233-237. Go to original source... Go to PubMed...
    4. Müller HL, Horwitz AE, Kühl J. Acute lymphoblastic leukemia with severe skeletal involvement: a subset of childhood leukemia with a good prognosis. Pediatr Hematol Oncol 1998; 15(2): 121-133. Go to original source... Go to PubMed...
    5. Sinigaglia R, Gigante C, Bisinella G et al. Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop 2008; 28(7): 20-28. Dostupné z DOI: <http://dx.doi.org/10.1097/BPO.0b013e318186eb99>. Go to original source... Go to PubMed...
    6. Riccio I, Marcarelli M, Del Regno N et al. Musculoskeletal problems in pediatric acute leukemia. J Pediatr Orthop B 2013; 22(3): 264-269. Dostupné z DOI: <http://dx.doi.org/10.1097/BPB.0b013e32835d731c>. Go to original source... Go to PubMed...
    7. Azorová L, Folber F. Epidemiológia akutnej lymfoblastickej leukémie dospelých v Juhomoravskom kraji. LF MU: Brno 2016. Samostatná studentská práce.
    8. Adamovičová D, Bližňáková M, Folber F. Laboratorní parametry u nově diagnostikované akutní lymfoblastické leukemie dospělých. LF MU: Brno 2016. Samostatná studentská práce.
    9. Arber DA, Orazi A, Hasserjian R et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016; 127(20): 2391-2405. Dostupné z DOI: <http://dx.doi.org/10.1182/blood-2016-03-643544>. Go to original source... Go to PubMed...
    10. Šálek C, Folber F, Froňková E et al. Early MRD response as a prognostic factor in adult patients with acute lymphoblastic leukemia. Eur J Haematol 2016; 96(3): 276-284. Dostupné z DOI: <http://dx.doi.org/10.1111/ejh.12587>. Go to original source... Go to PubMed...
    11. Brüggemann M, Raff T, Flohr T et al. Clinical significance of minimal residual disease quantification in adult patients with standard-risk acute lymphoblastic leukemia. Blood 2006; 107(3): 1116-1123. Go to original source... Go to PubMed...
    12. Gökbuget N, Kneba M, Raff T et al. Adult patients with acute lymphoblastic leukemia and molecular failure display a poor prognosis and are candidates for stem cell transplantation and targeted therapies. Blood 2012; 120(9): 1868-1876. Go to original source... Go to PubMed...
    13. Cole CH. Lessons from 50 years of curing childhood leukaemia. J Paediatr Child Health 2015; 51(1): 78-81. Dostupné z DOI: <http://dx.doi.org/10.1111/jpc.12803>. Go to original source... Go to PubMed...
    14. O'Brien S, Thomas DA, Ravandi F et al. Results of the hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone regimen in elderly patients with acute lymphocytic leukemia. Cancer 2008; 113(8): 2097-2101. Dostupné z DOI: <http://dx.doi.org/10.1002/cncr.23819>. Go to original source... Go to PubMed...
    15. Šálek C, Šponerová D, Soukupová Maaloufová J. Akutní lymfoblastová leukemie: historie a současnost. Vnitř Lék 2012; 58(Suppl 2): 20-26.
    16. Kantarjian H, Stein A, Gökbuget N et al. Blinatumomab versus Chemotherapy for Advanced Acute Lymphoblastic Leukemia. N Engl J Med 2017; 376(9): 836-847. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1609783>. Go to original source... Go to PubMed...
    17. Kantarjian HM, DeAngelo DJ, Stelljes M et al. Inotuzumab Ozogamicin versus Standard Therapy for Acute Lymphoblastic Leukemia. N Engl J Med 2016; 375(8): 740-753. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1509277>. Go to original source... Go to PubMed...
    18. Safety Study to Assess AFM11 in Patients With Relapsed or Refractory Adult B-precursor ALL. ClinicalTrials.gov Identifier: NCT02848911. Dostupné z WWW: <https://clinicaltrials.gov/ct2/show/NCT02848911>.
    19. Maude SL, Frey N, Shaw PA et al. Chimeric Antigen Receptor T Cells for Sustained Remissions in Leukemia. N Engl J Med 2014; 371(16): 1507-1517. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1407222>. Go to original source... Go to PubMed...
    20. Davila ML, Riviere I, Wang X et al. Efficacy and Toxicity Management of 19-28z CAR T Cell Therapy in B Cell Acute Lymphoblastic Leukemia. Sci Transl Med 2014; 6(224): 224ra25. Dostupné z DOI: <http://dx.doi.org/10.1126/scitranslmed.3008226>. Go to original source... Go to PubMed...
    21. Chang LJ, Dong L, Liu YC et al. Safety and Efficacy Evaluation of 4SCAR19 Chimeric Antigen Receptor-Modified T Cells Targeting B Cell Acute Lymphoblastic Leukemia - Three-Year Follow-up of a Multicenter Phase I/II Study. Blood 2016; 128: 587. Dostupné z WWW: <http://www.bloodjournal.org/content/128/22/587>. Go to original source...
    22. Gardner R, Leger KJ, Annesley CE et al. Decreased Rates of Severe CRS Seen with Early Intervention Strategies for CD19 CAR-T Cell Toxicity Management. Blood 2016; 128: 586. Dostupné z WWW: <http://www.bloodjournal.org/content/128/22/586>. Go to original source...

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