Extramedullary leukemic infiltration of the breast in adult acute lymphocytic leukemia (ALL) is rare. We report two such cases here. One patient died of relapsed ALL and the other was cured with local radiation therapy and remains alive and in remission 30 years after relapsing in her breast. A literature review of reported cases of ALL with breast involvement is discussed.
18012 Background: A direct correlation between the levels of hypotension during IL-2 treatment and response in melanoma has not yet been demonstrated, although both have been correlated with higher IL-2 doses and production of nitric oxide. Methods: A retrospective study analyzed the association between response to IL-2 and systolic, diastolic, mean blood pressure (BP), and heart rate (HR) at baseline and during treatment, by using the t-test. Further, same comparison was performed after BP was corrected for the amount of neosynephrine (neo) utilized during IL-2 treatment (subtracting the raise in BP produced by neo using individual patient coefficients). 22 patients (13 females, 9 males) with a median age of 54 years (range 36–71) received a total of 26 courses of IL-2 (between 2001–2005). Median number of prior treatments was 2.5 (range 0–5). Outcomes were divided in (A) responders (1CR, 3PRs and 4SDs), and (B) non-responders (18PD). Results: When adjusting for the effects of neo, the corrected mean BP during treatment was significantly lower in (A) compared to (B) (52.17 vs 64.34 mmHg, P = 0.018; mean difference −12.17, 95% CI −22.06 to −2.27). Similarly, the decrease in corrected mean blood pressure from baseline was greater in (A) (−34.89 vs −20.67 mmHg, P = 0.003; mean difference −14.22, 95% CI −23.09 to −5.37). A trend towards statistical significance was recorded for the variation in uncorrected mean BP (17.86 vs. 23.22 mmHg, P = 0.085; mean difference −5.36, 95% CI −11.53 to 0.80). Separate analysis demonstrated a significant drop in both systolic (−17.85 mmHg, P = 0.009; 95% −30.77 to −4.91) and diastolic (−12.05 mmHg, P = 0.01; 95% CI −21.02 to −3.07) corrected BP in (A) vs. (B), but no significant difference for either uncorrected parameters. No correlation between response and the HR, number of IL-2 doses or total quantity of neo was observed. Conclusions: Uncorrected variation in mean BP shows a trend towards significance in predicting response to IL-2. However, corrected mean, systolic and diastolic BP correlate closely with response to treatment. Implications of this association may reside in better outcomes for an intensive IL-2 treatment, with aggressive pressor support. A common pathogenetic basis for response to IL-2 and induction of hypotension is possible. No significant financial relationships to disclose.
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