In addition to smears with the usual stains, terminal transferase, myeloperoxidase, Sudan black B, and specific and nonspecific esterase histochemical stains are frequently helpful. Prognosis and Treatment Cure is a realistic goal for both ALL and AML, especially in younger patients. Treatment programs and clinical situations are complex and require an experienced team. Supportive care, which is typically greater for patients with AML, requires first-rate blood bank, pharmacy, laboratory, and nursing services. Bleeding, usually the consequence of thrombocytopenia, generally responds to platelet administration.
Infections are serious in the neutropenic, immunosuppressed patient.
Similarly, for fever in the neutropenic patient, combination antibiotic therapy should be given immediately after appropriate studies and cultures are obtained. Fungal infections are increasing in frequency and are difficult to diagnose. Empiric treatment with fungicidal drugs is indicated if antibacterial therapy is not effective in 48 to 72 h. In patients with refractory pneumonitis, Pneumocystis carinii or a viral infection should be suspected and confirmed by bronchoscopy and bronchoalveolar lavage and treated appropriately. Granulocyte transfusions may be helpful in neutropenic patients with gram-negative sepsis but have no proven benefit as prophylaxis.