Images in Clinical Medicine
Bone Marrow Involvement in Acute Leukemia
N Engl J Med 1998; 339:1375November 5, 1998
- Article
Figure 1 A genetically engineered, humanized antibody against CD25 (Tac, the interleukin-2–receptor α chain) was labeled with indium-111 and administered to a patient with CD25+ B-cell lymphoblastic leukemia at a dose of 1 mg per kilogram of body weight. The white-cell count decreased from 44,000 per cubic millimeter (80 percent blasts) to 11,000 per cubic millimeter (65 percent blasts) 3 hours after the intravenous infusion, with a further reduction over the next 16 hours. Nuclear scanning at 48 hours showed a marked redistribution of the antibody from the blood (indicated by the absence of visible cardiac and vascular structures on the scan) to extravascular tumor sites. The image delineates all marrow-containing bones (long bones, ribs, sternum, hips, and spine) in a “reverse x-ray–like” fashion, with displacement of red and yellow (fat) marrow by tumor. (Posterior structures are attenuated on this anterior film.) Biopsy showed that the marrow was packed with tumor. The radioactivity in the spleen and liver may have been due to tumor-cell infiltration or clearance of circulating antibody-coated cells. By way of contrast, in subjects without acute leukemia, there is persistent localization of the antibody in the blood pool and no uptake by bone marrow. The total mass of malignant cells in the marrow far exceeds that of the circulating tumor cells, graphically demonstrating the point that acute leukemia is a disease of the marrow.
R.P. Junghans, Ph.D., M.D.
Beth Israel Deaconess Medical Center, Boston, MA 02215- Citing Articles (1)
Citing Articles
1
H.B. Koon, P. Severy, D.S. Hagg, K. Butler, T. Hill, A.G. Jones, T.A. Waldmann, R.P. Junghans. (2006) Antileukemic effect of daclizumab in CD25 high-expressing leukemias and impact of tumor burden on antibody dosing. Leukemia Research 30:2, 190-203
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