All issues > Volume 34(5); 1991

Original Article

J Korean Pediatr Soc. 1991;34(5):720-729. Published online May 31, 1991.

A case of acute lymphoblastic leukemia complicating neuroblastoma in remission.

Dong Woo Son¹, Bum Soo Park¹, Jun Jae Kim¹, Hong Hoe Koo¹, Hee Young Shin¹, Hyo Seop Ahn¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Received: September 28, 1990;  Accepted: November 9, 1990.

Abstract

As childhood cancer survivors are now increasing in number owing to the improvements in diagnosis, staging, and treatment, concerns have been raised regarding the quality of survival of these patients. One of the limitation to quality and length of survival has been the development of second malignant neoplasm (SMN). In Korea, only one case of SMN has been reported. However, one can expect that the number of SMN will increase along with the increasing number of childhood cancer survivors. The pathogenesis of SMN is possibly related with treatment factors. SMN’s are so refractory to treatment that the prognosis of the patients are guarded. SMN occurring after neuroblastoma is extremely rare event, especially when the SMN is acute leukemia. We have experienced a case of acute lymphoblastic leukemia (L3) in treated neuroblas- toma. The patient, a 4-year-6-month-old boy was the product of the non-related parents. When his age was 100 days, 2 〜 3cm sized mass was first noted on his right thigh posteriorly. At the age of 14 months, excisional boipsy of the mass revealed malignancy. At that time, left adrenal mass was found. After the left adrenalectomy and biopsy, he was diagnosed as neuroblastoma. He was managed with vincristine and cyclophosphamide for 10 weeks and 6 months respectively. Total cumulative doses of the durgs were ; vincristine 7mg (15mg/M2), cyclophosphamide 4,325mg (8,650mg/M2). The evidence of residual disease was absent. In October 1988, 31 months after completion of chemother- apy, he was presented to us with a 12-day history of pallor and petechiae. Liver was palpable 5FB under the right subcostal margin. Spleen was palpable 8FB. Initial CBC were ; Hb 6.8gm/dl, WBC 37,800/mm3, platelet 28,000/mm3. With bone marrow aspiration and biopsy, he was diagnosed as acute lymphoblastic leukemia (B-cell type). Chemotherapy with D-COMP regimen was done. After the completion of induction chemotherapy, remission was achieved. But in December 1989, peripheral lymphoblasts were seen and bone metastasis was confirmed by bone scan and bone x-ray. Further treatment was refused by his parents. He expired in December 1989,14 months after the diagnosis of SMN.

Keywords :Second Malignant Neoplasm;Neuroblastoma;Acute Lymphoblastic Leukemia