Letter to the Editor
HIGH-DOSE METHYLPREDNISOLONE FOR THE TREATMENT OF PRIAPISM IN CHILDHOOD LEUKEMlA
Fatma Gumruk, MD, Gonul Hiponmez, MD, Sinasi Ozsoylu, MD, Aytemiz Gurgey, MD, and A. Murat Tuncer, MD, 0 University
Pediatr Hematol Oncol Downloaded from informahealthcare.com by University of Otago on 12/29/14 For personal use only.
of Hacettepe, Hacettepe Children's Hospital, Department of Pediatric Hematology, 06100 Ankara/Turkiye(Turkey)
Priapism is a rarely seen complication of childhood leukemias. Idiopathic priapism, sickle cell disease, trauma, retroperitoneal solid tumors, and acute and/or chronic leukemias have been reported as a cause of priapism in childhood. 1-6 Methods of therapy such as local and splenic radiotherapy, cold applications, analgesia, hydration, general or caudal anesthesia, irrigation/ aspiration, and some surgical interventions such as glans-cavernosum shunt and/or sapheno-cavernosum shunt have been used'-6 and aggressive therapy has been recommended in children for prevention of the late complications such as impotence.' We would like to report on two leukemic children who presented with priapism and who have been treated successfully with high-dose methylprednisolone (HDMP). Case 1, an 8-year-old boy, was referred with a history of painful erection and difficulty in urination for 1 day, Positive physical findings were pallor and hepato-splenomegaly and priapism. O n admission, his hemoglobin (Hb) level was 7.02 g/dL, Hct was 2 8 % , platelet count was 40,000/mm3, and his WBC count was 537,000/mm3 with 100% blast cells. Bone marrow examination confirmed the diagnosis of acute lymphoblastic leukemia (ALL-L2, B-cell phenotype). Treatment with HDMP in a dose of 30 mg/kg/day was initiated orally as a single agent. Allopurinol, hydration, and alkalinization with sodium bicarbonate for the treatment of hyperuricemia were also given. On the fourth day of therapy 50% recovery in the size of priapism was observed. He Pediatric Hematology and Oncolou, 8.367-368, 1991 Copyright @ 1991 by Hemisphere Publishing Corporation
367
Pediatr Hematol Oncol Downloaded from informahealthcare.com by University of Otago on 12/29/14 For personal use only.
368
F. GUMRUK ET A 1
has been in a complete remission for 7 months without recurrence of priapism. Case 2, a 7-year-old boy, was admitted to our hospital with the complaint of painful erection and difficulty in urination for 2 days. The abnormal physical findings were hepato-splenomegaly and priapism. Laboratory data on admission were as follows: Hb level 8.84 g/dL, Hct 28%, platelet count 282,000/mm3, and WBC count 400,000/mm3 with 4% promyelocytes, 4 % myelocytes, 44 % metamyelocytes, 38 % polymorphonuclear leukocytes, and 10 % lymphocytes. A cellular bone marrow aspiration was compatible with the diagnosis of chronic myelocytic leukemia. His Hb F level was 2.6 % , leukocyte alkaline phosphatase was 4.1 IU, and Ph chromosome was negative. Hb S was not present and Hb A, was 1.3%. Oral HDMP (30 mg/kg/day) and busulphan (2 mg/day) were started. Three days after initiation of this therapy, the priapism was reduced by approximate 70% of its original size. Since then, treatment was continued with busulphan alone. The child has been in the remission of 18 months. Because of the inhibitor effects of steroids on granulocyte adhesiveness, mega-dose steroids (2 g/day) have been advised for the treatment of vascular leukostasis in CNS leukemia.' We suggest here that HDMP may also be considered an effective and noninvasive therapeutic approach to priapism.
REFERENCES 1 . Vadakan VV, Ortega J . Priapism in leukemia. Cancer. 1972;30:373-375. 2. Winter CC, McDowell G . Experience with 105 patients with priapism: update review of all aspects. J . Urol. 1988;140:980-983. 3. Irken G, Ozsoylu S . Priapism in a child with adult type chronic granulocytic leukemia: case report. Cocuk Sac ve Hst DUE. 1988;31:189-191. 4. Yildiz I, Ozsahin H, Ozbek S. Priapism in a child with acute lymphoblastic leukemia. Acta Paediatr Scand. 1991;80:553-554. 5. Suri R , Goldman JM, Catovsky D, Johnson SA, Wiltshaw E, Galton DAG. Priapism complicating chronic granulocytic leukemia. A m J Hematol. 1980;9:295-299. 6 . Dewan PA, Tan HL, Auldist SW, Moss MCL. Priapism in childhood. BrJ Urol. 1989;64:541-545. 7. Mykulak DJ, Glassberg KI. Impotence following childhood priapism. J Urol. 1990;144:134-135. 8. Jacob HS. Pulse steroids in hematologic diseases. Hosp &act. 1985;8:87-90. Received January 7, 1991 Accepted March 5, 1991 Address correspondence to A . Murat Tuncer.
HIGH-DOSE METHYLPREDNISOLONE FOR THE TREATMENT OF PRIAPISM IN CHILDHOOD LEUKEMlA
Fatma Gumruk, MD, Gonul Hiponmez, MD, Sinasi Ozsoylu, MD, Aytemiz Gurgey, MD, and A. Murat Tuncer, MD, 0 University
Pediatr Hematol Oncol Downloaded from informahealthcare.com by University of Otago on 12/29/14 For personal use only.
of Hacettepe, Hacettepe Children's Hospital, Department of Pediatric Hematology, 06100 Ankara/Turkiye(Turkey)
Priapism is a rarely seen complication of childhood leukemias. Idiopathic priapism, sickle cell disease, trauma, retroperitoneal solid tumors, and acute and/or chronic leukemias have been reported as a cause of priapism in childhood. 1-6 Methods of therapy such as local and splenic radiotherapy, cold applications, analgesia, hydration, general or caudal anesthesia, irrigation/ aspiration, and some surgical interventions such as glans-cavernosum shunt and/or sapheno-cavernosum shunt have been used'-6 and aggressive therapy has been recommended in children for prevention of the late complications such as impotence.' We would like to report on two leukemic children who presented with priapism and who have been treated successfully with high-dose methylprednisolone (HDMP). Case 1, an 8-year-old boy, was referred with a history of painful erection and difficulty in urination for 1 day, Positive physical findings were pallor and hepato-splenomegaly and priapism. O n admission, his hemoglobin (Hb) level was 7.02 g/dL, Hct was 2 8 % , platelet count was 40,000/mm3, and his WBC count was 537,000/mm3 with 100% blast cells. Bone marrow examination confirmed the diagnosis of acute lymphoblastic leukemia (ALL-L2, B-cell phenotype). Treatment with HDMP in a dose of 30 mg/kg/day was initiated orally as a single agent. Allopurinol, hydration, and alkalinization with sodium bicarbonate for the treatment of hyperuricemia were also given. On the fourth day of therapy 50% recovery in the size of priapism was observed. He Pediatric Hematology and Oncolou, 8.367-368, 1991 Copyright @ 1991 by Hemisphere Publishing Corporation
367
Pediatr Hematol Oncol Downloaded from informahealthcare.com by University of Otago on 12/29/14 For personal use only.
368
F. GUMRUK ET A 1
has been in a complete remission for 7 months without recurrence of priapism. Case 2, a 7-year-old boy, was admitted to our hospital with the complaint of painful erection and difficulty in urination for 2 days. The abnormal physical findings were hepato-splenomegaly and priapism. Laboratory data on admission were as follows: Hb level 8.84 g/dL, Hct 28%, platelet count 282,000/mm3, and WBC count 400,000/mm3 with 4% promyelocytes, 4 % myelocytes, 44 % metamyelocytes, 38 % polymorphonuclear leukocytes, and 10 % lymphocytes. A cellular bone marrow aspiration was compatible with the diagnosis of chronic myelocytic leukemia. His Hb F level was 2.6 % , leukocyte alkaline phosphatase was 4.1 IU, and Ph chromosome was negative. Hb S was not present and Hb A, was 1.3%. Oral HDMP (30 mg/kg/day) and busulphan (2 mg/day) were started. Three days after initiation of this therapy, the priapism was reduced by approximate 70% of its original size. Since then, treatment was continued with busulphan alone. The child has been in the remission of 18 months. Because of the inhibitor effects of steroids on granulocyte adhesiveness, mega-dose steroids (2 g/day) have been advised for the treatment of vascular leukostasis in CNS leukemia.' We suggest here that HDMP may also be considered an effective and noninvasive therapeutic approach to priapism.
REFERENCES 1 . Vadakan VV, Ortega J . Priapism in leukemia. Cancer. 1972;30:373-375. 2. Winter CC, McDowell G . Experience with 105 patients with priapism: update review of all aspects. J . Urol. 1988;140:980-983. 3. Irken G, Ozsoylu S . Priapism in a child with adult type chronic granulocytic leukemia: case report. Cocuk Sac ve Hst DUE. 1988;31:189-191. 4. Yildiz I, Ozsahin H, Ozbek S. Priapism in a child with acute lymphoblastic leukemia. Acta Paediatr Scand. 1991;80:553-554. 5. Suri R , Goldman JM, Catovsky D, Johnson SA, Wiltshaw E, Galton DAG. Priapism complicating chronic granulocytic leukemia. A m J Hematol. 1980;9:295-299. 6 . Dewan PA, Tan HL, Auldist SW, Moss MCL. Priapism in childhood. BrJ Urol. 1989;64:541-545. 7. Mykulak DJ, Glassberg KI. Impotence following childhood priapism. J Urol. 1990;144:134-135. 8. Jacob HS. Pulse steroids in hematologic diseases. Hosp &act. 1985;8:87-90. Received January 7, 1991 Accepted March 5, 1991 Address correspondence to A . Murat Tuncer.
