HEALTH DEPARTMENT OF UKRAINE
STATE SPECIALIZED CHILDREN’S HOSPITAL OKHMATDET

Chornovola 28/1
01135, Kiev, Ukraine
Tel. 236-6942
Fax. 236-6165

CASE RECORD №128
Yaroslav Tenetko
Year of birth: 17.07.2007.
Address: Kirilenko Street, 6/ 403, Krivoi Rog, Ukraine

Yaroslav Tenetko underwent medical treatment for juvenile myelomonocytic leukemia during the period from August, 21 to September, 1, 2009 at the oncohematology department. The case was first diagnosed at the Russian Children’s Clinical Hospital (Moscow) in July, 2009.
Patient complaints: general weakness, enlargement of abdomen, hyperthermia. Patient was in poor condition on the admission to hospital, caused by the prior disease with underlying hyperleukocytosis, hepatosplenomegaly, hypoproteinemia, toxic syndrome, anemic syndrome, oliguria, and anasarca.
Blood test result on admission: L-135(109 /L) (5% of blast cells; 4% of promyelocytes; 4% of myelocytes; 6% of metamyelocytes, 14% of band cells, 47% of segmentated cells; 15% of monocytes; 5% of lymphocytes); Hg 70 g/l; platelets 24(109 /L).
Therapy: detoxication therapy, antimicrobial therapy (sulperason + netilmicin sulfate + metrogyl), replacement therapy (platelet concentrate transfusion AB (IV) #2; erythrocyte concentrate AB (IV) negative #1), trimetabol, hydroxyurea 500 mg/d, from August, 31, 2009 – 1000 mg/d; allopurinol.
While in hospital, the patient’s condition became stable (the temperature came to normal, peripheral oedema dissipated and abdomen reduced due to free fluid excretion).
August 28, 2009 blood test result: L-41(109 /L), Hb 77 g/l, platelets 16(109 /L).
Due to the augmentation of leukocytosis up to 61(109 /L) (blood test result on August, 31, 2009) it was decided to increase the hydroxyurea dose up to 1000 mg/d.
The only radical treatment mode is allogenic bone marrow transplantation from a relative or alternative donor.
The blood samples of Yaroslav and his sibling (elder brother) was sent for HLA typing to Israel on August, 30, 2009.
While the possibility of carrying out the allogenic bone marrow transplantation is under consideration, Yaroslav is discharged from the hospital and is followed up by a hematologist at the place of residence.

RECOMMENDATIONS:
1. Weekly clinical blood analysis control; biweekly biochemical blood assay.
2. Taking hydroxyurea in the dose of 1000 mg/d until September, 6, 2009, then, if white blood count is lower than 50(109/L), reducing the dose to 500 mg/d.
3. In case of an augmentation of leukocytosis or parenchymal organs, taking cytosar for 10 days (15 mg/m2 intravenously or subcutaneously).
4. Taking allopurinol (100mg/d) during the whole period of cytoreduction (withdrawal at L< 25(109/L).

01.09.09.

Chief of the oncohematology department N. A. Kubalya