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February 10, 1975

Hodgkin Disease With Acute Lymphoblastic Leukemia

Author Affiliations

From the Department of Medicine, St. Agnes Hospital, White Plains, NY (Dr. Grant), and the Division of Hematology, New York Hospital-Cornell Medical Center, New York (Dr. Coleman).

JAMA. 1975;231(6):623. doi:10.1001/jama.1975.03240180059019

THE PROGNOSIS in acute lymphoblastic leukemia (ALL) has greatly improved because of effective chemotherapy, irradiation, or both for the prevention of central nervous system (CNS) leukemia. As prolonged remissions become more frequent, larger concern now focuses on the undesirable consequences of therapy.1 Immunosuppression is the most serious problem, since this is thought to lead to the fatal nonbacterial infections seen increasingly during remissions.2 Treatment may also potentiate the development of a second neoplasm, as shown in the following case report.

Report of a Case  In December 1972, a 17-year-old boy found to have acute lymphoblastic leukemia was admitted to St. Agnes Hospital. Hematological remission was obtained with vincristine sulfate, prednisone, and daunorubicin. He also received three courses of methotrexate intrathecally and craniospinal irradiation to a total of 1,800 R as prophylaxis against CNS leukemia. Therapy was maintained with mercaptopurine and methotrexate, with periodic reinforcement by the three drugs