OC (Study No. 30089) is a 5-year-old boy referred on account of a 2-week history of severe pallor and high grade fever. Examination revealed pallor, significant peripheral lymph node enlargements and hepatosplenomegaly (6 and 10 cm BCM respectively). Blood counts showed PCV - 13%, WBC – 920,000/µl (lymphoblasts 97%, neutrophils 3%, slides 3 - 6), Plt – 124,000/µl. Lymphoblasts were uniform, with cleaved nuclei, open chromatin and deeply basophilic vacuolated cytoplasms. Similar cells were found constituting >95% of the nucleated bone marrow cells. CSF samples also revealed significant malignant pleocytosis (slides 1 & 2). Features were in keeping with acute lymphoblastic leukemia (FAB L3, i.e. Burkitt-type).
 
Serum chemistry was essentially normal. He was then commenced on hydration, allopurinol, supportive red cell transfusion, and the 14-day-cycle COM regimen (as used for Burkitt lymphoma: IV cyclophosphamide 1.2 g/m2, IV vincristine 1.4 mg/m2 and IV methotrexate 75 mg/m2 on Day 1; IT methotrexate 12 mg days 1 & 8, and IT cytarabine 50 mg day 4). By day 6, repeat blood counts were now PCV - 32%, WBC – 600/µl (mature lymphocytes 80%, neutrophils 20%), Plt – 40,000/µl. Platelet concentrates and prophylactic antimicrobials were commenced. At the end of the 1st cycle, blood counts were PCV - 24%, WBC – 1,600/µl (mature lymphocytes 85%, neutrophils 15%, no blasts), Plt – 55,000/µl.
 
Second cycle had to delayed for 10 days, until absolute neutrophils counts reach 1,040/µl. Repeat marrow aspirate at the time of starting 2nd cycle showed normal myeloblasts <1%. He is presently stable and doing well in remission, and is scheduled to receive 6 cycles of the COM+IT regimen.