ccml Sunday's Case - 4 days Later

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Pret,
do you have any references for the proven causes of ALL in adults?
My sister is currently battling ALL (having bone marrow ablative chemo as we 
speak) and I am her bone marrow donor this Thursday. We will beat this 
bastard:-))

We have not been able to identify any risk factors for her disease (Having 7 
kids doesn't count, does it??). She has had about 2 chest Xrays in her life 
and no CT scans prior to getting the disease. Zillions of them since, but 
such is the nature of chronic illness. No radiation exposure at all that she 
can identify.

All anecdotal, but there has to be some other causative factor for this 
bloody disease.
thanks
Jenny
Paramedic in Oz

----- Original Message ----- 
From: "Bjorn, Pret" <pbjorn at emh.org>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Sent: Tuesday, January 30, 2007 2:32 AM
Subject: RE: ccml Sunday's Case - 4 days Later


Hold on a bit.  I'm not certain the Xie paper is as optimistic or as 
definitive as you claim.  Read beyond the abstract.

Peds cases are up, the elderly are down, sure; but everyone in between is 
simply untrendable.  At the same time, the subtype analysis in this very 
population shows a significant increase in the proportion of acute
lymphocytic leukemia (ALL).

ALL is typically thought of as a "pediatric" version of the disease 
(accounting for about three-quarters of cases in kids).  In adults, it has 
always been comparatively rare and notoriously difficult to survive.


As far as I know -- although it's been awhile since I looked -- the only 
proven environmental risk factor for adult-onset ALL is radiation exposure.

Of course not all of the possible environmental permutations have been 
studied, and we must admit that the environment has been pretty badly 
permutated in the past several decades.  Further, the risk/benefit in
trauma patients (as opposed to total body scans marketed as birthday gifts) 
favors finding occult injury.  But the take-home message here is simple and 
beyond debate: scans are not harmless.

Pret Bjorn, RN
Bangor, ME USA

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