Blindness during remission in two patients with acute lymphoblastic leukemia. A possible complication of multimodality therapy
Two patients with acute lymphoblastic leukemia treated on the same protocol became blind during complete remission. Therapy consisted of systemic combination chemotherapy, prophylactic central nervous system irradiation and monthly intrathecal cytosine arabinoside. Eight months after CNS irradiation...
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| Veröffentlicht in: | Cancer 1977-01, Vol.39 (1), p.58-61 |
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| container_title | Cancer |
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| creator | Margileth, David A. Poplack, David G. Pizzo, Phillip A. Leventhal, Brigid G. |
| description | Two patients with acute lymphoblastic leukemia treated on the same protocol became blind during complete remission. Therapy consisted of systemic combination chemotherapy, prophylactic central nervous system irradiation and monthly intrathecal cytosine arabinoside. Eight months after CNS irradiation visual acuity in both patients began to decrease. Meningeal leukemia in the area of the chiasm was suspected but despite additional radiotherapy, steroids and continued intrathecal therapy, both patients were blind within 6 months. Numerous lumbar punctures were negative for leukemic cells. Extensive investigation, including craniotomy in one case, failed to reveal the cause of blindness. Biopsy of the optic nerve in one case was compatible with radiation toxicity. We postulate that potentiation of radiation toxicity to the optic nerves and chiasm by systemic chemotherapy, intrathecal chemotherapy, or both, may have led to blindness. The patients continue in complete hematologic and CNS remission 12 and 29 months after becoming blind. |
| doi_str_mv | 10.1002/1097-0142(197701)39:1<58::AID-CNCR2820390111>3.0.CO;2-5 |
| format | Article |
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A possible complication of multimodality therapy</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Margileth, David A. ; Poplack, David G. ; Pizzo, Phillip A. ; Leventhal, Brigid G.</creator><creatorcontrib>Margileth, David A. ; Poplack, David G. ; Pizzo, Phillip A. ; Leventhal, Brigid G.</creatorcontrib><description>Two patients with acute lymphoblastic leukemia treated on the same protocol became blind during complete remission. Therapy consisted of systemic combination chemotherapy, prophylactic central nervous system irradiation and monthly intrathecal cytosine arabinoside. Eight months after CNS irradiation visual acuity in both patients began to decrease. Meningeal leukemia in the area of the chiasm was suspected but despite additional radiotherapy, steroids and continued intrathecal therapy, both patients were blind within 6 months. Numerous lumbar punctures were negative for leukemic cells. Extensive investigation, including craniotomy in one case, failed to reveal the cause of blindness. Biopsy of the optic nerve in one case was compatible with radiation toxicity. We postulate that potentiation of radiation toxicity to the optic nerves and chiasm by systemic chemotherapy, intrathecal chemotherapy, or both, may have led to blindness. The patients continue in complete hematologic and CNS remission 12 and 29 months after becoming blind.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/1097-0142(197701)39:1<58::AID-CNCR2820390111>3.0.CO;2-5</identifier><identifier>PMID: 264409</identifier><language>eng</language><publisher>New York: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Acute Disease ; Adult ; Blindness - complications ; Blindness - etiology ; Brain - radiation effects ; Child, Preschool ; Cytarabine - administration & dosage ; Cytarabine - adverse effects ; Drug Therapy, Combination ; Female ; Humans ; Injections, Spinal ; Leukemia, Lymphoid - complications ; Leukemia, Lymphoid - therapy ; Methotrexate - administration & dosage ; Methotrexate - adverse effects ; Optic Nerve - pathology ; Radiotherapy - adverse effects ; Remission, Spontaneous</subject><ispartof>Cancer, 1977-01, Vol.39 (1), p.58-61</ispartof><rights>Copyright © 1977 American Cancer Society</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/264409$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Margileth, David A.</creatorcontrib><creatorcontrib>Poplack, David G.</creatorcontrib><creatorcontrib>Pizzo, Phillip A.</creatorcontrib><creatorcontrib>Leventhal, Brigid G.</creatorcontrib><title>Blindness during remission in two patients with acute lymphoblastic leukemia. A possible complication of multimodality therapy</title><title>Cancer</title><addtitle>Cancer</addtitle><description>Two patients with acute lymphoblastic leukemia treated on the same protocol became blind during complete remission. Therapy consisted of systemic combination chemotherapy, prophylactic central nervous system irradiation and monthly intrathecal cytosine arabinoside. Eight months after CNS irradiation visual acuity in both patients began to decrease. Meningeal leukemia in the area of the chiasm was suspected but despite additional radiotherapy, steroids and continued intrathecal therapy, both patients were blind within 6 months. Numerous lumbar punctures were negative for leukemic cells. Extensive investigation, including craniotomy in one case, failed to reveal the cause of blindness. Biopsy of the optic nerve in one case was compatible with radiation toxicity. We postulate that potentiation of radiation toxicity to the optic nerves and chiasm by systemic chemotherapy, intrathecal chemotherapy, or both, may have led to blindness. The patients continue in complete hematologic and CNS remission 12 and 29 months after becoming blind.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Blindness - complications</subject><subject>Blindness - etiology</subject><subject>Brain - radiation effects</subject><subject>Child, Preschool</subject><subject>Cytarabine - administration & dosage</subject><subject>Cytarabine - adverse effects</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Humans</subject><subject>Injections, Spinal</subject><subject>Leukemia, Lymphoid - complications</subject><subject>Leukemia, Lymphoid - therapy</subject><subject>Methotrexate - administration & dosage</subject><subject>Methotrexate - adverse effects</subject><subject>Optic Nerve - pathology</subject><subject>Radiotherapy - adverse effects</subject><subject>Remission, Spontaneous</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1977</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkV1rFDEUhkNR61r7D3qRS3sx6znJZD5Wsayj_YDiglTwLiSzmW4088EkwzI3_nazrBTs1eHw8Bw470vIFcISAdh7hDJPAFP2Dss8B7zk5Qo_imK1Wt99Sapv1XdWMOAlIOInvoRltfnAEnFCFk_mC7IAgCIRKf_5mrzx_ldccyb4KXnFsjSFckH-fHa223bGe7qdRts90tG01nvbd9R2NOx7OqhgTRc83duwo6qegqFuboddr53ywdbUmel3tNSSrunQR1k7Q-u-HZytoxxP9Q1tJxds22-Vs2GmYWdGNcxvyctGOW_O_80z8uP660N1m9xvbu6q9X0ysPhfIgwWHHKR8bQxqVGibjQoA5nKNdbQ8IaL2hhWNDwShAw0x1Kj1qVIWVbwM3JxvDtMujVbOYy2VeMsjzFErI94b52ZnyiCPHQhD4nKQ6Ly2IXkpUQpChmrkP9XIbkEWW0kk-IZ4X8BKK6GXQ</recordid><startdate>197701</startdate><enddate>197701</enddate><creator>Margileth, David A.</creator><creator>Poplack, David G.</creator><creator>Pizzo, Phillip A.</creator><creator>Leventhal, Brigid G.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope></search><sort><creationdate>197701</creationdate><title>Blindness during remission in two patients with acute lymphoblastic leukemia. A possible complication of multimodality therapy</title><author>Margileth, David A. ; Poplack, David G. ; Pizzo, Phillip A. ; Leventhal, Brigid G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p2111-5e183075634fe4ea5cfb0ae06a7b1c0f3f35cee28f3cfb1060b319b1bb9542683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1977</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Blindness - complications</topic><topic>Blindness - etiology</topic><topic>Brain - radiation effects</topic><topic>Child, Preschool</topic><topic>Cytarabine - administration & dosage</topic><topic>Cytarabine - adverse effects</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Humans</topic><topic>Injections, Spinal</topic><topic>Leukemia, Lymphoid - complications</topic><topic>Leukemia, Lymphoid - therapy</topic><topic>Methotrexate - administration & dosage</topic><topic>Methotrexate - adverse effects</topic><topic>Optic Nerve - pathology</topic><topic>Radiotherapy - adverse effects</topic><topic>Remission, Spontaneous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Margileth, David A.</creatorcontrib><creatorcontrib>Poplack, David G.</creatorcontrib><creatorcontrib>Pizzo, Phillip A.</creatorcontrib><creatorcontrib>Leventhal, Brigid G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Margileth, David A.</au><au>Poplack, David G.</au><au>Pizzo, Phillip A.</au><au>Leventhal, Brigid G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blindness during remission in two patients with acute lymphoblastic leukemia. A possible complication of multimodality therapy</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>1977-01</date><risdate>1977</risdate><volume>39</volume><issue>1</issue><spage>58</spage><epage>61</epage><pages>58-61</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><abstract>Two patients with acute lymphoblastic leukemia treated on the same protocol became blind during complete remission. Therapy consisted of systemic combination chemotherapy, prophylactic central nervous system irradiation and monthly intrathecal cytosine arabinoside. Eight months after CNS irradiation visual acuity in both patients began to decrease. Meningeal leukemia in the area of the chiasm was suspected but despite additional radiotherapy, steroids and continued intrathecal therapy, both patients were blind within 6 months. Numerous lumbar punctures were negative for leukemic cells. Extensive investigation, including craniotomy in one case, failed to reveal the cause of blindness. Biopsy of the optic nerve in one case was compatible with radiation toxicity. We postulate that potentiation of radiation toxicity to the optic nerves and chiasm by systemic chemotherapy, intrathecal chemotherapy, or both, may have led to blindness. The patients continue in complete hematologic and CNS remission 12 and 29 months after becoming blind.</abstract><cop>New York</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>264409</pmid><doi>10.1002/1097-0142(197701)39:1<58::AID-CNCR2820390111>3.0.CO;2-5</doi><tpages>4</tpages></addata></record> |
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| ispartof | Cancer, 1977-01, Vol.39 (1), p.58-61 |
| issn | 0008-543X 1097-0142 |
| language | eng |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Acute Disease Adult Blindness - complications Blindness - etiology Brain - radiation effects Child, Preschool Cytarabine - administration & dosage Cytarabine - adverse effects Drug Therapy, Combination Female Humans Injections, Spinal Leukemia, Lymphoid - complications Leukemia, Lymphoid - therapy Methotrexate - administration & dosage Methotrexate - adverse effects Optic Nerve - pathology Radiotherapy - adverse effects Remission, Spontaneous |
| title | Blindness during remission in two patients with acute lymphoblastic leukemia. A possible complication of multimodality therapy |
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