Leukaemia :: Health, T-Cell

In a small subset of patients with precursor T-cell lymphoblastic lymphoma, there is t (8; 13); consequently, the fibroblast growth factor receptor 1 locus and a zinc finger protein gene are involved. FIP1L1-PDGFRA fusion gene generated by del (4) has also been shown in patients with lymphoblastic leukemias and eosinophilia. However, the exact underlying mechanism of eosinophilia is not yet known (6-10). The majority of patients with ALL /Eo are boys with median age of 14. The definite diagnosis of ALL may be delayed from several months to even 2 years .This is in some part due to the lack of blasts in circulating blood.The cardio respiratory system is frequently involved in ALL/Eo that may be responsible for a poorer prognosis of this entity compared to the standard ALL (4, 11). It is not uncommon to confront cardiac involvement in leukaemia. Cardio toxicity of chemotherapeutic drugs, heart failure and precipitated coronary events are typical examples (12, 13). Moreover, opportunistic infections such as fungi may invade the cardiac chambers (14). The heart may be directly involved by tumoral infiltration ranging from gross cardiac masses to microscopic infiltrations. Myo- pericardial involvement and valvular changes have been reported in association with lymphoma and leukaemia,but not early in the disease course(15, 16). There are few numbers of cases with ALL/Eo initially presented with cardiac mass; so the best therapeutic regimen in such patients has not yet been defined. L- Asaparaginase should be used cautiously in chemotherapy regimen of ALL/Eo since there are fears of thromboembolic events triggered by synergistic procoagulant effect of this drug and eosinophilia. Ronald S.Go et al reported a case of ALL/Eo treated by L-asparginase based regimen that developed fatal deep vein and intracardiac thromboses (17). It is not exactly known when a gross cardiac mass disappears with the beginning of chemotherapy in a patient with ALL/Eo. Nie YL, et al reported a 17-year old girl with ALL/Eo that was presented initially with congestive heart failure and left ventricular endocardial thrombosis. The thrombosis resolved 8 weeks after chemotherapy (12). Barbaric D, et al reported a 15 year- old boy with ALL who had a large echo dense mass in the right ventricle at the time of diagnosis. The mass resolved as early as 5 days after commencing chemotherapy (18). Aissi K, et al reported a case of a 29 –year-old man with ALL/Eo who had congestive heart failure at the presentation.