MR, a 56 year old woman with a history of thrombocytopenia, was diagnosed with MDS. Bone marrow showed MDS, with dysplastic myeloid and erythoid lineages, decreased megakaryocytes and with 25% myeloblasts. Karyotype was 46XX. She was pancytopenic, requiring red cell and platelet transfusions and was given empiric antibiotics for neutropenic fever. ATO, 20 mg/day IV was given (32 doses) with a 3-day treatment break to allow diuresis. After 3 weeks of ATO, she was no longer neutropenic, nor did she require red cell or platelet transfusion. Her treatment was stopped due to development of clinically significant peripheral neuropathy. Serial Vibratron testing, used in this study to detect toxic distal axonopathy, demonstrated a doubling of vibratory sensation threshold during the 4 weeks of ATO treatment, from 3.7 vu at baseline to 8.8 vu at end of treatment. This correlated with the development in the last week fo treatment of clinical neuropathy in both upper and lower extremities. Now, 8 months later, with no further treatment, the neuropathy has improved considerably. She remains transfusion independent, with a normal white blood cell and granulocyte count, and normal hematocrit. Her platelet count is 7090,000/uL. Marrow biopsy at completion of ATO was hypercellular with improved maturation of myeloid and erythroid lines, and megakaryocytes. Her marrow was poorly aspirable throughout treatment and in vitro studies of marrow cultured with ATO could not be completed for technical reasons. This study is ongoing with accrual of patients with myeloid and lymphoid leukemias, MDS, lymphoma and myeloma.
|Original language||English (US)|
|Issue number||11 PART II|
|Publication status||Published - Dec 1 2000|
ASJC Scopus subject areas
- Cell Biology