Case Report
A 5.5-month-old girl admitted to our hospital with swelling on the cheek. Her physical examination revealed that she had ectrodactyly on right hand (Figure 1). She was tachypneic. She had splenomegaly (2 cm bellow coastal margin) and umbilical hernia with abdominal distention. Routine blood test results revealed anemic hemoglobin level of 5.9 g/dl, increased leukocyte count 26 570 /mm3 and platelet count of 104 000/mm3 with peripheral blasts. In addition LDH level increaesed to 1126 U/L, liver function and renal funtion tests were in normal range. Echocardiographic and chest radiography findings were normal. Right forearm radiography showed 2-4th phalangial bone aplasia (Figure 1). Abdominal sonography revealed two fold enlarged kidney. Bone marrow examination revealed 52 % L1 type lymphoblasts, which had high positivity for CD 19, CD22, CD38, cyM, cy TDT, cy 79a ve HLA DR. Only 12% of blasts were dim and other blasts were negative for CD10. She hadn’t central nervous system infiltration. Chemotherapy was started according to BFM İnterfant -2006. She had a good prednisolon response and minimal residual disease at day 15 of induction therapy showed low risk. Bone marrow aspiration at the end of the induction therapy complete remission was achieved with no blast. At the same time her kidney dimensions at sonography revert to normal. She has continued to consolidiation therapy according to the BFM interfant 2006 protocol.