A 68-year-old male with a blastic crisis of chronic myelogeneous leukemia was admitted for the chemotherapy.
He had a marked splenomegaly but neither edema nor dehydration. On hematologic examination anemia, thrombocytopenia and an appearance of a lot of immature cells and basophils in peripheral blood were noted. The other laboratory tests including serum electrolyte and renal function showed no abnormalities.
The patient was given 40 mg/m2 of prednisolone for 4 days and 1.4 mg/m2 of vincristine (VCR) on the day 1 and the day 7. During the following week, the improvement on hematologic examination was observed, however, his appetite decreased markedly and severe fatigability appeared. At the day 14, low serum sodium and chloride, low plasma osmorality, high excretion of sodium and chloride in the urine, and high urine osmorality were observed. Serum sodium reached to the bottom of 100 mEq/L at the day 19.
By the day 50 after admission, the patient recovered from hyponatremia with severe water restriction and the oral medication of demecrocycline. In the following hospital day, the patient was controlled with prednisolone and vindesine sulfate (VDS). The first injection (0.5 mg/m2) and the following three times injection (1.4 mg/m2) of VDS of every 3 or 4 weeks had no effect on the serum electrolyte and osmorality.
The blastic crisis of CML seems to be well controlled with VDS and prednisolone as well as VCR and prednisolone. The patient has no complaint and is followed up as an outpatient.
