Isolated Hepatic Recurrence

A 47-year-old male with relapsed B-cell ALL in his liver, who initially appeared to have hepatic veno-occlusive disease (now known as sinusoidal obstructive syndrome, SOS) of the liver. The blasts expressed CD19, CD20, HLADR, CD10, CD34 and intracellular TDT. The patient was treated with hyper CVAD parts A and B for eight cycles, along with intrathecal methotrexate as prophylaxis and also had an LDH level of greater than 1200. Immediately went into a full remission. He continued to be in remission throughout eight cycles of hyper CVAD but then relapsed two months after his eighth and final cycle. He was then treated on the Larson regimen in preparation for a transplant. Specifically, the patient received reinduction with an asparaginase containing regimen, which also included daunorubicin, vincristine and prednisone. On day 15 of the cycle, started to develop hyperbilirubinemia as well as swelling in his abdomen; he later developed massive and refractory ascites. There was no portal vein, hepatic vein or inferior cava thrombosis. He had no hepatosplenomegaly at the time of relapse. He was also pancytopenic. He was treated with supportive care, which included hydration, diuretics and transfusions.

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Last date updated on September, 2024