Treatment of Acute Lymphatic Leukemia With Aminopterin

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THERE are no specific measures for the treatment of acute lymphatic leukemia. A small number of patients experience periods of spontaneous improvement which last for varying lengths of time.1 The most recent addition to the therapeutic agents employed for the disease has been the folic acid antagonists. Of these preparations aminopterin* has given the most promising results. The present report summarizes the response observed to aminopterin in 12 consecutive cases of acute lymphatic leukemia.

Aminopterin exerts a toxic action not only upon the granulocytic cells of the bone marrow, but also upon the erythrocytic and megakaryocytic constituents. Its effects in any given patient cannot be predicted beforehand. In acute lymphatic leukemia with lymphocytosis, aminopterin usually causes a sharp fall in the total white blood cell count but when there is lymphopenia instead of lymphocytosis the leukocyte count may either fall still further or rise toward normal. Toxic effects include pronounced hypoplasia of granulocytic and erythrocytic precursors in the bone marrow, erythroid maturation arrest at the megaloblast stage, and further suppression of platelet maturation.

The results of treatment with aminopterin are summarized in table 1 and are similar to the results reported by others.2,3,4,5 In 5 of the 12 patients there was no detectable clinical benefit and no improvement in the blood picture. In the remaining 7 patients, however, both subjective and objective improvement occurred. In these 7 persons there was a decrease in the total number and the percentage incidence of circulating “blast cells,” and in most of the patients. . .



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