title: Dysplastic bone marrow changes during maintenance therapy for acute leukemia.
abstract: We describe the case of an 8-year-old girl with common precursor B-cell acute lymphoblastic leukemia who presented with severe pancytopenia during maintenance therapy with methotrexate and 6-mercaptopurine. The bone marrow smear showed moderate hypocellularity and trilinear dysplastic changes consistent with a diagnosis of drug toxicity, with no evidence of lymphoblasts. Flow cytometric immunophenotyping was negative for leukemic cells. Blood cell counts normalized after treatment with folinic acid. Maintenance therapy was gradually restarted and she remained well at follow-up visits. Myelotoxicity from methotrexate and 6-mercaptopurine may represent an unpredictable incident during an otherwise uneventful maintenance therapy, and may occur independently of other organ toxicities.
authors.affiliation: *Department of Medical, Surgical and Health Sciences, University of Trieste ‡Institute for Maternal and Child Health IRCCS "Burlo Garofolo," Trieste †San Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Chinello
authors.forename: Samuele
authors.initials: S
authors.lastname: Naviglio
authors.forename: Alison
authors.initials: A
authors.lastname: Shardlow
authors.forename: Alessandro
authors.initials: A
authors.lastname: Severino
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ventura
authors.forename: Anna
authors.initials: A
authors.lastname: Locasciulli
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001855:Bone Marrow Diseases / Q000139:chemically induced*; D002648:Child; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015122:Mercaptopurine / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011379:Prognosis
chemical_list: D015122:Mercaptopurine; D008727:Methotrexate