bluuebunny/crossref_metadata_2025 huggingface dataset:
Reversible encephalopathy and seizures as a result of conventional vincristine administration
Authors: Hurwitz Richard L. , Mahoney Donald H. , Armstrong Dawna L , Browder Timothy M.
Published: February 2007

An 8‐year‐old child with acute lymphoblastic leukemia (ALL) developed seizures associated with bilateral lucencies on CT scan during standard induction therapy with vincristine and prednisone. Because of the progressive nature of her symptoms, a brain biopsy was performed and revealed neurotu‐bular dissociation, which, in experimental animal models, is characteristic of vincristine toxicity. All other causes of encephalopathy have been ruled out. The drug was withheld and the clinical symptoms and findings resolved. The occurrence of unusual and severe neurologic side effects during the course of conventional induction therapy for childhood ALL warrants careful evaluation for evidence of vincristine toxicity.
Long‐term survival of children with acute non‐lymphoblastic leukemia
Authors: Odom Lorrie F. , Morse Helvise , Tubergen David G. , Blake Marilyn
Published: February 2007

Results of a pilot protocol employing chemoimmunotherapy for treatment of 23 children with acute non‐lymphoblastic leukemia consecutively diagnosed between 1975 and 1979 are reported. Twenty‐two children achieved remission, ten of whom are surviving 6.5–9.5 years after completion of primary systemic therapy (median 7.8 years). Treatment consisted of intermittent courses of Daunomycin, Cytosine Arabinoside, 6‐Thioguanine, VP‐16, with or without Decadron.

Connaught BCC applied between courses of chemotherapy for the first 8 months of treatment, and cranial irradiation/intrathecal Cytosine Arabinoside in early first remission. Five patients with leukemic cells in spinal fluid at diagnosis had myelomonoblastic or monoblastic subtypes and a median diagnostic white blood cell count (WBC) of 149,000/mm3compared with a median WBC of 12,000/mm3for the other 18 patients (P= .007).
Subacute myelopathy: An unusual paraneoplastic complication of Hodgkin's disease
Authors: Dansey R. D. , Hammond‐Tooke G. D. , Lai K. , Bezwoda W. R.
Published: February 2007

We report a case of Hodgkin disease presenting with a subacute myelopathy without evidence of metastatic involvement of the spinal cord. The systemic disease responded to conventional chemotherapy, but the myelopathy only improved after intrathecal dexa‐methasone was added to the treatment program, β‐2‐microglobulin levels in the cere‐brospinal fluid were elevated at presentation. Following the use of intrathecal corticoste‐roids there was a decrease of CSF β2‐microglobulin levels. The possible significance of these findings is discussed.
High‐dose methotrexate improves clinical outcome in children with acute lymphoblastic leukemia: St. Jude total therapy study X
Authors: Abromowitch Minnie , Ochs Judith , Pui Ching‐Hon , Kalwinsky David , Rivera Gaston K. , Fairclough Diane , Look A. Thomas , Hustu H. Omar , Murphy Sharon B. , Evans William E. , Dahl Gary V. , Bowman W. Paul
Published: February 2007

High‐dose methotrexate (HDMTX, 1,000 mg/m2) and cranial irradiation/sequential chemotherapy (RTSC) were compared for ability to extend complete remission durations in children with acute lymphoblastic leukemia (ALL). Three hundred thirty patients were enrolled in the study, according to our criteria for standard‐risk ALL: a leukocyte count < 100 × 109/L, no mediastinal mass, no leukemic involvement of the central nervous system (CNS), and blast cells lacking sheep erythrocyte receptors and surface immunoglobulin. Prednisone‐vin‐cristine‐asparaginase induced complete remissions in 95% of the patients, who were then randomized to receive either HDMTX (n = 154) or RTSC (n = 155). HDMTX was administered with intrathecal MTX for the first 3 weeks following remission induction, and then every 6 weeks with daily mercaptopurine (MP) and weekly oral MTX for a total of 18 months. The RTSC regimen consisted of 1,800 cGy cranial irradiation and intrathecal MTX for 3 weeks, followed by MP/MTX, cyclophosphamide/doxorubicin, and teniposide/cytarabine administered sequentially over 18 months. The final 12 months of treatment for both groups was MP and oral MTX; all patients received intrathecal MTX every 12 weeks.

With a median follow‐up of 5 years, complete remission durations have been significantly longer among children treated with HDMTX, compared with RTSC (P = .049) or historical institutional control regimens (P = .002). Approximately 67% of the patients receiving HDMTX and 56% of those receiving RTSC are expected to be in continuous complete remission at 4 years. Overall, isolated CNS relapse rates were similar (P = .17) in the two treatment groups, although by newer risk criteria cranial irradiation could be expected to provide better protection in patients with an unfavorable prognosis. These findings indicate that addition of intermittent HDMTX infusions to conventional chemotherapy is an effective method for extending complete remissions in children with ALL.
Chemotherapy of advanced head and neck cancer: Updated results of a randomized trial of the order of administration of sequential methotrexate and 5‐fluorouracil
Authors: MacKintosh John F. , Coates Alan S. , Tattersall M. H. N. , Swanson Cheryl
Published: February 2007

One hundred and twenty‐seven patients with advanced or recurrent squamous cell carcinoma of the head and neck (HNC) were randomized to treatment with methotrexate (MTX) followed 1 hour later by 5‐fluorouracil (5‐FU) (sequence MF), or 5‐fluorouracil followed after 1 hour by methotrexate (sequence FM). One hundred and seventeen patients were evaluable for response. There was no significant difference in response rates between the MF and FM sequences. Overall, 8 patients (6.8%) achieved complete response (CR) and 46 (39.3%) partial response (PR). In 95 previously untreated patients, the overall response rate (CR + PR) was 50%, compared with 31% for previously treated patients (P = 0.02). Survival duration significantly favored the FM sequence in univariate analyses (P = 0.04). Stepwise multivariate Cox model analysis showed that poor performance status (Eastern Cooperative Oncology Group) at study entry (P < 0.001) and prior radiotherapy (P = 0.03) were significant adverse predictors for survival. When allowance was made for these factors, a survival difference in favor of the FM sequence remained (P = 0.003). Sequential MTX followed 1 hour later by 5‐FU is not recommended for treatment of HNC.
T4 + (helper phenotype) chronic lymphocytic leukemia: Case report with liver failure and literature review
Authors: Greer John P. , Cousar John B. , Miller Robert F. , Vogler Larry B. , Goodin Julia C. , Graber Stanley E. , Collins Robert D.
Published: February 2007

T‐cell lymphomas and leukemias are a heterogeneous group of neoplasms found in each anatomic compartment of the T system (marrow, thymus, and various peripheral tissues) and that have varying phenotypic expressions. Histopathologic features of the thymic and peripheral T neoplasms do not fit into a clearly defined pattern, and clinical expressions of T neoplasms are likewise variable. This report describes a 60‐year‐old man with “chronic” lymphocytic leukemia of T4 + (helper) phenotype. Rapid deterioration in liver function, presumably due to tumor infiltration, was unexpected and has not previously been reported. The unusual clinical and pathologic features are reviewed in the context of T‐cell neoplasms, particularly T4 + processes.
Chemotherapeutic management of epidural neuroblastoma
Authors: Hayes F. A. , Green A. A. , O'Connor D. M.
Published: February 2007

Nine children with neuroblastoma and spinal cord compression were managed initially with chemotherapy induction without laminectomy or radiotherapy. Of the nine children seven are neurologically normal, one has minimal residual deficits, and one remains paraplegic. The excellent results in these children, plus nine patients previously reported, emphasizes the validity of this approach in children with epidural extension of neuroblastoma.
Response of agranulocytosis to thymectomy in a patient with thymoma and chronic lymphocytic leukemia
Authors: Weir Alva B. , Dow Lois W.
Published: February 2007

A patient with chronic lymphocytic leukemia presented with recurrent episodes of severe neutropenia. This neutropenia was initially responsive to prednisone but even tually became refractory. A spindle‐cell thymoma was diagnosed and resected with dramatic improvement in his granulocytopenia. Both autologous and heterologous granulocyte macrophage colony growth were clearly inhibited by the patient's serum. This is the first reported case of severe granulocytopenia associated with a thymoma that seemed to be reversed following thymectomy.
123I‐metaiodobenzylguanidine scintigraphy of ectopic intracranial retinoblastoma
Authors: Bomanji J. , Kingston J. E. , Hungerford J. L. , Britton K. E.
Published: February 2007

Radioiodinated metaiodobenzylguanidine (MIBG) has been used for diagnostic purposes to image neural crest tumors. We report the uptake of 123I MIBG in a child with ectopic intracranial retinoblastoma. It is felt that 123I MIBG scintigraphy may have a role in detecting occult metastatic disease in these patients.
Avascular necrosis of bone in bone marrow transplant patients
Authors: Russell J. A. , Blahey W. B. , Stuart T. A. , Edwards G. , Card R. T.
Published: February 2007

Avascular necrosis of the hips occurred in two patients after allogeneic bone marrow transplantation. One had been receiving steroid therapy for prophylaxis of graft‐versus‐host disease, the other for the treatment of this condition. This complication has been reported infrequently, but the incidence could be as high as 10% in long‐term survivors of bone marrow transplantation. While other drugs and irradiation may also contribute to this condition, it is likely that steroids are the major cause. An awareness of this risk should encourage minimizing the use of steroid therapy after bone marrow transplantation.
Mitoxantrone and high‐dose ara‐C in refractory malignancies: A phase I trial
Authors: Smith William J. , Muss Hyman B. , Capizzi Robert L. , White Douglas R. , Richards Frederick , Jackson Don V. , Powell Bayard L. , Zekan Patricia J.
Published: February 2007

On the basis of in vitro studies demonstrating marked synergy between mitoxantrone and high‐dose cytosine arabinoside (ara‐C) (HiDAC) against L5178Y murine leukemia and clinical studies showing usefulness of the combination in patients with refractory acute myeloid leukemia, a phase I study was initiated to find tolerable doses for use in patients with refractory solid tumors. Initial dose levels were mitoxantrone 2 mg/m2 infused over 30 minutes, followed by high‐dose ara‐C 750 mg/m2 infused over 3 hours repeated once at 24 hours (total dose 4 mg/m2 mitoxantrone and 1,500 mg/m2 Hi‐DAC per 2‐day course), with planned subsequent escalation of mitoxantrone. Moderate‐to‐severe myelosuppression, however, required sequential dose reduction of both agents. Nonhematologic toxicity was restricted to manageable nausea and vomiting in one‐half the patients and a single episode of transient delirium of uncertain etiology. No responses were observed in 23 heavily pretreated patients with a wide variety of malignancies.

On the basis of this study, doses of 187–375 mg/m2 ara‐C given every 24 hours for two doses following mitoxantrone 1 mg/m2 every 24 hours for two doses would be tolerated by most patients with subsequent dose escalation in some as allowed by myelosuppression.
Treatment of metastatic malignant melanoma with trimetrexate: A phase II study
Authors: Odujinrin Oluwole , Goldberg David , Doroshow James , Leong Lucille , Margolin Kim , Grove William , Carr Brian , Akman Steven
Published: February 2007

Trimetrexate glucuronate, a nonclassical antifolate, was administered to 14 patients with recurrent and progressive metastatic malignant melanoma. Thirteen patients were evaluable for response and toxicity. Five patients had received prior treatment consisting of immunotherapy (one patient), immunotherapy plus radiotherapy (one patient), radiotherapy (one patient), chemotherapy (one patient), or radiotherapy and chemotherapy (one patient). The starting dose of trimetrexate was 8 mg/m2 given as an intravenous bolus daily for 5 consecutive days of a 21‐day cycle. Subsequent cycles of therapy were escalated by 25% based on individual patient tolerance. A median of two courses of trimetrexate was administered (range 1–4). No patient demonstrated a measurable objective response to this treatment regimen. Trimetrexate was well‐tolerated; toxicity was mild and consisted primarily of myelosuppression or nausea and vomiting. At the dose level and schedule used in this study, trimetrexate was not effective for the treatment of disseminated malignant melanoma.
Intraperitoneal and systemic chemotherapy for advanced endometrial adenocarcinoma: A case report
Authors: Vaughn Clarence B. , Chapman Janet L. , Herschman Barry R. , Bonczak Michael J. , Treisman Edward J. , Groshko Gayle A. , Nirenberg Pauline L.
Published: February 2007

Five to ten percent of patients with adenocarcinoma of the endometrium present with advanced disease [1] or develop metastasis and require systemic therapy for control of disease. About one‐third (33%) of recurrent or advanced endometrial cancer responds to progestational agents [2–4]. The efficacy of a single chemotherapeutic agent in endometrial adenocarcinoma is in the range of 20–30% [5–7]. Multidrug programs have produced a response rate between 30% to 70% in advanced cancer of the endometrium [8–12]. Knapp et al. [13] and Esposito et al. [14] reported that the intraperitoneal route of chemotherapy administration produced peak concentration of the drug in the abdomen that was 30–400 times that attained by the intravenous route. This case report illustrates a favorable response in advanced endometrial adenocarcinoma to a multiagent program consisting of intraperitoneal administration of two agents and an oral progestational agent.
Acute superior vena caval thrombosis after central venous catheter removal: Successful treatment with thrombolytic therapy
Authors: Theriault Richard L. , Buzdar Aman U.
Published: February 2007

The use of central venous catheters for the administration of cancer chemotherapy has become commonplace, but a variety of potential complications related to catheter use have been clinically recognized. We report a patient in whom acute superior vena cava thrombosis developed after removal of a central venous catheter used to administer chemotherapy for breast cancer. Prompt clinical recognition and therapy resulted in resolution of the thrombus, both clinically and radiographically.
Nosocomial septicemia in the cancer patient: The influence of central venous access devices, neutropenia, and type of malignancy
Authors: Morrison Vicki A. , Peterson Bruce A. , Bloomfield Clara D.
Published: February 2007

Nosocomial septicemias that occurred over a 32‐month period on an inpatient medical oncology service were reviewed. One hundred four episodes of septicemia occurred in 84 patients, 33% with solid tumors and 67% with leukemia or lymphoma. Sixty were primary septicemias, with the remainder being secondary. Of the 118 isolates recovered, 42% were Gram‐positive organisms, 45% Gram‐negative organisms, and 13% were fungi. Coagulase‐negative staphylococci and Escherichia coli were the most common Gram‐positive and Gram‐negative isolates, respectively. The effect of the type of malignancy, neutropenic status, and presence of a central venous access device (CVAD) on the isolate(s) recovered was studied. Coagulase‐negative staphylococci were more commonly isolated from leukemia‐lymphoma patients (26% vs. 3%, P<.01), while Gram‐negative isolates (63% vs. 36%, P = .01), specifically Klebsiella species (21% vs. 5%, P = .02), were more common in solid tumor patients. Staphylococcus aureus was isolated more frequently from non‐neutropenic patients than from those with neutropenia (19% vs. 4%, P = .02). Gram‐positive isolates were more commonly found in patients with a CVAD (51% vs. 29%, P = .03), in particular coagulase‐negative staphylococci (29% vs. 2%, P<.001). In contrast, Gram‐negative isolates (62% vs. 34%), especially Klebsiella species (22% vs. 3%, P <.01) and S. aureus (18% vs. 5%, P = .07) were more commonly isolated from patients with no CVAD. Neither neutropenia nor the presence of a CVAD predisposed to early mortality. Our data suggest that empiric antimicrobial coverage for presumed nosocomial septicemia in the febrile cancer patient should include vancomycin for patients with a CVAD to cover coagulase‐negative staphylococci and a cephalosporin for patients with solid tumors, especially those without a CVAD, to cover Klebsiella species.
Pulmonary fibrosis associated with low‐dose adjuvant methyl‐CCNU
Authors: Block Margaret , Lachowiez Robert M. , Rios Carlos , Hirschl Simon
Published: February 2007

Pulmonary fibrosis is a serious side effect of nitrosourea therapy, occurring most frequently in patients treated with BCNU. Pulmonary fibrosis developed in a 63 year‐old male patient while being treated with adjuvant methyl‐CCNU for rectal carcinoma. This toxicity is rare with methyl‐CCNU, having only been reported once previously. The case of methyl‐CCNU‐induced pulmonary fibrosis reported here occurred at a much lower total dose than the first reported case (604 mg/m2 vs. 2,733 mg/m2). Details of the case history, including radiographic and pathologic findings, are presented.
Malignant pericardial tamponade
Authors: Rinkevich D. , Borovik R. , Bendett M. , Markiewicz W.
Published: February 2007

We studied the clinical course and management of 27 patients with malignant pericardial tamponade seen in a single Medical Center over a 10 year period. Patients treated with repeat pericardial tap as their only mode of therapy had a high rate of recurrent tamponade (6 of 13 subjects) whereas most patients treated with drainage (either surgical or percutaneous) had sustained control of their pericardial effusion (achieved in 10/13 subjects). Intra‐pericardial instillation of tetracycline or cyclophosphamide did not clearly improve the good results obtained with drainage alone. Extensive pericardiectomy was required in 2 patients only.

Irrespective of the mode of therapy, survival was poor in patients with carcinoma of lung (N = 10) with a median survival of 30 days only vs. 135 days for patients with breast carcinoma (N = 10).

Patients with malignant pericardial tamponade are best treated with immediate drainage. Percutaneous and sub‐xiphoid surgical drainage are equally effective. Despite invasion of the pericardium by carcinoma, patients with a good oncologic prognosis may enjoy an appreciable survival with adequate quality of life following relief of tamponade.
Juvenile chronic myelocytic leukemia: Experience with intensive combination chemotherapy
Authors: Festa Robert S. , Shende Ashok , Lanzkowsky Philip
Published: February 2007

Six children with juvenile chronic myelocytic leukemia (JCML) with adverse prognostic features were treated with intensive combination chemotherapy similar to that utilized in patients with acute nonlymphocytic leukemia (ANLL). Despite obtaining hematologic remissions after induction therapy, clinical findings of extramedullary disease persisted. The use of intensive post‐induction chemotherapy did not erradicate persistent extramedullary disease, and all patients developed hematologic relapse and progressive disease at a median of 8 months. The median survival of the treated patients was 15 months. The use of intensive ANLL therapy in poor prognosis JCML does not improve the survival rates reported with less intensive regimens but does have value in producing hematologic remissions that may be useful in preparing patients for bone marrow transplant.
Excessive chemotherapy‐related granulocytopenia in a child with non‐Hodgkin's lymphoma and a congenital abnormality of purine salvage
Authors: Blatt Julie
Published: February 2007

A girl with non‐Hodgkin's lymphoma and immunodeficiency based on absence of the purine salvage pathway enzyme purine nucleoside phosphorylase experienced profound neutropenia while receiving combination chemotherapy with cyclophosphamide, vincristine, methotrexate, and prednisone (COMP). Neutropenia was most severe following courses that included either systemic or intrathecal methotrexate, even in the face of major dose reductions. Delays in the development of neutropenia‐during periods of leucovorin administration also implicate methotrexate as the primary responsible agent. This case suggests that certain immunodeficiency states predispose patients to extensive chemotherapy‐induced myelosuppression and supports the concept that purine salvage is a clinically important mechanism for modulating methotrexate toxicity.
Prevalence of naevocytic naevi after chemotherapy for childhood cancer
Authors: De Wit P. E. J. , De Vaan G. A. M. , De Boo Th. M. , Lemmens W. A. J. G. , Rampen F. H. J.
Published: February 2007

The frequency of naevocytic naevi (moles) in patients with childhood haematologic malignancies was studied. All patients had received multiple chemotherapy. The majority had also received cranial irradiation as part of their central nervous system leukaemia/lymphoma prophylaxis. Total body mole counts of the patients were compared with those of their healthy brothers and sisters. The median number of moles in the patient group was 20.0 (n = 79), in the healthy sibs 11.0 (n = 88). In two subgroups mole counts of male and female patients were compared with those of their closest brother or sister. There were 19 male and 19 female pairs for comparison. Median numbers of moles were significantly higher in both patient groups than in the controls (P<0.05). It is suggested that multiple chemotherapy (and/or cranial irradiation) may induce or activate naevocytic naevi. These findings may have important implications with regard to the aetiology of melanoma.
Effect of abdominal irradiation on growth in boys treated for a wilms′ tumor
Authors: Wallace W. H. B. , Shalet S. M. , Morris‐Jones P. H. , Swindell R. , Gattamaneni H. R.
Published: February 2007

To study the effect of abdominal irradiation on spinal growth in childhood we have measured final height, sitting height, and leg length in 30 male survivors of a Wilms′ tumor. Twenty‐one patients received whole abdominal irradiation by either megavoltage therapy (MV: n=11) or orthovoltage therapy (OV: n=10); the remainder received flank irradiation. To examine the effect of the adolescent growth spurt on the irradiated spine we have followed prospectively seven patients who received whole abdominal irradiation and nine patients who received flank irradiation through puberty.

Compared to a normal population there is a modest reduction in median final standing height SDS (H.SDS: −1.15) accompanied by a marked reduction in median final sitting height SDS (S.HT SDS: −2.41) with no apparent effect on median subischial leg length SDS (SILL.SDS: 0.04). This reduction in spinal growth is reflected by a strongly positive disproportion score (DPS; [SILL SDS — S.HT SDS] +2.81). The incidence of scoliosis after abdominal irradiation has been low (10%). During puberty there is a significant fall in median sitting height SDS after both whole abdominal (median fall: −0.9, P=0.02) and flank irradiation (median fall: −1.85, P=0.01), and this is reflected in a significant increase in disproportion (DPS: whole abdominal; median rise +1.4, P=0.02: flank, median rise +134, P=0.01). After MV irradiation there is a significant correlation between the degree of disproportion and the age at treatment (P <0.0005).

The younger the patient is at treatment the more severe is the restriction on spinal growth and the shorter and more disproportionate they become as an adult. The estimated eventual loss in potential height from abdominal irradiation at the age of one is 10 cm and at five years is 7 cm.
Clinical trial and pharmacokinetics of carboplatin 560 mg/m2 in children
Authors: Doz Francois , Brugières Laurence , Bastian Gérard , Quintana Erica , Lemerle Jean , Zucker Jean‐Michel
Published: February 2007

We report a clinical trial with carboplatin (CBDCA) in 15 children with malignant solid tumors recurrent after or resistant to conventional treatment. Based on previous phase I clinical trials, these children were given a dose of CBDCA 560 mg/m2 by intravenous infusion every 4 weeks.

The study includes a pharmacokinetic analysis of CBDCA in three patients. This clinical trial shows the feasibility of this CBDCA schedule, even after high cumulative doses of previous chemotherapy. As expected the main toxicity was hematologic but the risk of renal and ototoxicity is not excluded and these functions have still to be monitored when this relatively high dose of CBDCA chemotherapy is used.
Decrease in childhood neuroblastoma death in Japan
Authors: Hanawa Yoshiyuki , Sawada Tadashi , Tsunoda Akio
Published: February 2007

Death statistics cards under 15 years of age submitted between 1979 and 1987 and coded as malignant neoplasms of organs or sites, in which neuroblastoma might affect, were inspected. A total of 1,037 cases of neuroblastoma death were identified.

Total number of neuroblastoma deaths among those under 15 years of age ranged between 118 and 145 from 1979 to 1984. However, after 1985 the number of deaths showed a declining tendency Down to 89 in both 1985 and 1986 and totalling only 93 in 1987. This declining tendency was mostly‐seen among children between 1 to 4 years of age. In this age group, the rate of death in 1987 was about one half of that in 1979; In the other age groups no declining tendency of neuroblastoma death was found.

The reason for the decrease in neuroblastoma death among children in Japan may be a result of widespread mass‐screening for neuroblastoma. However, further study is necessary before any final conclusions can be drawn.
Histological, immunohistochemical, and chromosomal studies on non‐adrenal neuroblastomas without increased excretion of catecholamines and their metabolites in urine
Authors: Sakatoku H. , Komada Y. , Hamazaki Y. , Kamiya H. , Sakurai M.
Published: February 2007

We reviewed our records for the last 10 years and found three of the 36 patients with neuroblastoma did not excrete significantly increased quantities of catecholamine metabolites in urine. All of these tumors were histologically characterized by small round cells and possessed a few dense core granules on the electron microscopic examination. All of them were reacted with anti‐neuron‐specific enolase (NSE) antibodies, OKB2, Pl153/3 monoclonal antibodies (Mo‐Abs). The HNK‐1, BA‐1, and SJ‐9A4 MoAbs reacted with two out of three. One of them demonstrated a reciprocal translocation involving the short arm deletion of chromosome 1. This multidisciplinary study has been helpful in making more accurate diagnoses for neuroblastoma without classical clinical characters.
Breast nodules as the initial site of relapse in childhood leukemia
Authors: Weinblatt Mark E. , Kochen Joseph
Published: February 2007

Two children with acute monoblastic leukemia in remission developed breast nodules that were the initial sites of disease relapse. Shortly after the appearance of disease in this site, the children developed marrow recurrence and, despite additional treatment, rapidly deteriorated and died from pancytopenia‐related complications. The importance of careful breast examination is stressed as part of the surveillance physical examination for children with monoblastic leukemia.
Metaiodobenzylguanidine (mIBG) in treatment of 47 patients with neuroblastoma: Results of the German neuroblastoma trial
Authors: Klingebiel Thomas , Berthold Frank , Treuner Jörn , Schwabe Dirk , Fischer Manfred , Feine Ulrich , Maul Frank D. , Waters Werner , Wehinger Helmut , Niethammer Dietrich
Published: February 2007

From 1984 to 1989, 47 children with relapsed, refractory, and/or metastasized neuroblastoma were treated with 131l‐metaiodobenzylguanidine (mlBG) in several different treatment combinations. At initial diagnosis, 36 children had Evans stage IV and 11 stage III disease. In 16 of the 47 children, tumor recurred after complete remission prior to mlBG treatment, 26 of 47 progressed from residual or nonresponding tumor, and in 5 of 47 tumor progression during chemotherapy was observed. Altogether the children were treated with a total of 112 courses (range 1–6) with a mean dosage of 8.9 ± 6.7 mCi/kg body weight/treatment course. Total dose was 283.2 ± 203.7 mCi for stage III and 388.9 ± 218.6 mCi for stage IV. Nine of 47 children reached a complete or a very good partial remission (CR and VGPR) from mlBG treatment alone, 13 of 47 achieved partial remission (PR). In an early analysis, 10 patients treated with mlBG in the neuroblastoma trial NB 85 of the German Society of Pediatric Oncology showed no significant difference in survival time compared with 30 conventionally treated children. However, the recent therapy series has been done with higher doses of mlBG, and during improved therapeutic scanning many more bone lesions could be detected than during earlier diagnostic scanning. We conclude that mlBG treatment has not yet fulfilled the expectations for it but still seems for certain indications to be a promising tool to treat neuroblastoma in the future. Moreover, the frontier of neuroblastoma detection is still advancing.
Longitudinal growth in children with non‐Hodgkin's lymphoma and children with acute lymphoblastic leukemia: Comparison between unirradiated and irradiated patients
Authors: Márky Ildikó , Samuelsson Bengt‐Olof , Mellander Lotta , Karlberg Johan
Published: February 2007

Longitudinal growth was studied in children treated for non‐Hodgkin's lymphoma (NHL). The aim of the study was to compare these children's growth velocity with findings in a previous study we performed on age‐matched children with acute lymphoblastic leukemia (ALL) who received cranial irradiation. Nine children with NHL with an onset time of treatment between 4 and 9 years of age (mean 6.5 years) were studied with annual body measurements taken from the time of the diagnosis and thereafter annually during the following 4 years. None of the children received cranial irradiation. During the first treatment year a significantly low mean height velocity was observed (−1.4 standard deviation score [SDS]) for the NHL group. The consecutive two 1 year periods showed a normalization of the mean height velocity. For the group of children with ALL, there was a more prominent negative effect on height during the first 2 years of treatment than for the NHL group in the present study. After the cessation of therapy, the children with NHL showed a reduced catch‐up growth compared with the children with ALL. The explanation offered is that cranial irradiation has a heavier impact on growth than chemotherapy during the first 2 years of treatment, but an intense chemotherapy during the maintenance period could have a considerable impact in blunting growth.
Bulbar and pseudobulbar palsy complicating therapy with high‐dose cytosine arabinoside in children with leukemia
Authors: Shaw Peter J. , Procopis Peter G. , Menser Margaret A. , Bergin Mary , Antony Jayne , Stevens Michael M.
Published: February 2007

Three of 38 children given high‐dose cytosine arabinoside therapy developed a previously undescribed complication. Neurological problems are a frequent occurrence in patients given this therapy, particularly cerebellar ataxia, but the development of bulbar and pseudobulbar palsy has not been reported. In two of these cases, it was sufficiently marked for the course of treatment to be curtailed and occurred at a relatively low cumulative dose of the drug. Neurotoxicity can occur at any time using high‐dose cytosine therapy.
Autologous bone marrow transplantation with 4‐hydroperoxycyclophosphamide‐purged marrow for acute lymphoblastic leukemia
Authors: Gonzales‐Chambers Rowena , Przepiorka Donna , Shadduck Richard K. , Borochovitz Dennis , Bloom Elana J. , Colvin O. Michael , Mangan Kenneth F. , Rosenfeld Craig S.
Published: February 2007

Ten patients age 13–52 years with acute lymphoblastic leukemia (ALL) in first complete remission (CR) (1), second CR (6), or relapse (3) were treated with cyclophosphamide 50 mg/kg daily × 4 and total body irradiation 3 Gy daily × 4 followed by infusion of autologous marrow purged with 4‐hydroperoxycyclophosphamide (4‐HC) at 100–120 μg/mL. The patients transplanted in relapse also received 2 mg vincristine and corticosteroids. All marrows were harvested while patients were in CR. The nucleated marrow cell dose was 3.5 ± 0.7 × 108/kg, and the CFU‐GM content of the transplant was 0.4 ± 0.5 × 103/kg after purging with 4‐HC. Median time from transplantation is 48 months. The neutrophil count (ANC) exceeded 1.0 × 109/L at a median of 26 days and platelets exceeded 50 × 109/L at 34 days. All patients were in remission after transplantation (ABMT). Five patients relapsed 2–9 months after ABMT (actuarial rate 60%). Three patients are alive and in CR at 17+, 43 +, and 54+ months after ABMT. Purging marrow with 4‐HC did not adversely affect engraftment, but it is not clear if the high relapse rate was due to incomplete ex vivo purging or inadequacy of the conditioning regimen.
Malignant lymphomas in children in the Netherlands in the period 1973‐1985: Incidence in relation to leukemia: A report from the dutch childhood leukemia study group
Authors: Coebergh Jan Willem W. , van der Does‐van den Berg Anna , Kamps Willem A. , Rammeloo Johan A. , Valkenburg Hans A. , van Wering Elisabeth R.
Published: February 2007

A retrospective study was done of the incidence of non‐Hodgkin's lymphoma (NHL) in children in the Netherlands in the period 1973‐85 in relation to that of acute lymphoblastic leukemia (ALL). Complete ascertainment of cases was most likely achieved through the network of cooperating pediatricians of the Dutch Childhood Leukemia Study Group (DCLSG). The incidence of NHL remained constant at 0.75 per 105 children per year; the boy/girl ratio was 2.5. In ±25% of cases the disease was localized at diagnosis. Of children with NHL who were not listed in the DCLSG leukemia register, 19% had ±25% lymphoblasts in the bone marrow at diagnosis, representing an overlap with ALL of ±5%. In 1% of the children with NHL an immuno‐deficiency disorder preceded the diagnosis. The incidence of Hodgkin's disease (HD) was 0.3 per 105 children per year, with some fluctuation over time, the peak being 0.7 in 1983. The boy/girl ratio was 2.7. Age‐specific incidence rates, clinical features of NHL and HD, as well as the ALL to NHL ratio corresponded with those in other European countries and for white children in the USA.
Reversible neurotoxicity following hyperfractionated radiation therapy of brain stem glioma
Authors: Griebel Maye , Friedman Henry S. , Halperin Edward C. , Wiener M. David , Marks Lawrence , Oakes W. Jerry , Hoffman John M. , DeLong G. Robert , Schold S. Clifford , Hockenberger Beverly , Freeman Carolyn R. , Kun Larry
Published: February 2007

Two patients with brain stem gliomas were treated with hyperfractionated radiation therapy (HFR) (7,020 and 7,560 cGy, respectively). Despite initial clinical improvement during irradiation, both patients demonstrated clinical deterioration approximately 3 weeks after completion of radiotherapy. Cranial magnetic resonance imaging (MRI) revealed a progressive increase in distribution of abnormal brain stem signal consistent with either tumor or edema. 18FDG positron emission tomography (PET) was obtained in one patient and demonstrated a hypermetabolic lesion at diagnosis and a hypometabolic lesion at the time of clinical deterioration postirradiation. Management with a tapering dose of dexametha‐sone alone resulted in marked clinical (both patients) and radiogaphic (one patient) improvement, allowing reduction or discontinuation of this medication. These results suggest that patients with brain stem tumors demonstrating clinical and radiographic evidence of progressive tumor shortly after completion of HFR should be initially managed conservatively with dexamethasone, since these findings may be manifestations of reversible radiation‐related neurotoxicity.
Pancreatoblastoma: Response to chemotherapy
Authors: Vannier Jean‐Pierre , Flamant Françoise , Hemet Jacques , Caillaud Jean Michel , Gruner Max , Bachy Bruno , Lefur René , Lemerle Jean , Tron Philippe
Published: February 2007

Two cases of pancreatoblastoma in children are reported here. Only biopsies were made at laparotomy as surgical resection by duodeno‐pancreatectomy was not possible. In both children a dramatic response was observed with chemotherapy: doxorubicin plus cisplatin for one, cyclophosphamide, actinomycin D, bleomycin, vinblastin sulfate, and cisplatin for the other. After completion of the chemotherapy the first patient had a local resection; then he had radiotherapy. He is alive in first remission 40 months after the end of the treatment. In the second patient, regional recurrence occurred 8 months after chemotherapy was ended. A transient second remission was obtained with ifosfamide plus etoposide alternating with epirubicin plus vincristine. The patient died 36 months after the diagnosis. Therefore, these two cases suggest that chemo therapy may be proposed before any attempt at surgical excision. Nevertheless, early consolidation by radical resection or irradiation must be considered.
Effectiveness and toxicity of cisplatin and doxorubicin (PLADO) in childhood hepatoblastoma and hepatocellular carcinoma: A siop pilot study
Authors: Ninane Jacques , Perilongo Giorgio , Stalens Jean‐Philippe , Guglielmi Maurizio , Otte Jean‐Bernard , Mancini Antonia
Published: February 2007

Sixteen children, aged 16 days to 13 years with hepatoblastoma (HB) (13 patients) or hepatocellular carcinoma (HCC) (3 patients), were given a total of 89 courses of cisplatin and doxorubicin (PLADO) as IV continuous infusion. All tumors were confined to the liver except for 1 hepatoblastoma patient with pulmonary metastases at presentation. Tumor response to PLADO was evaluable in 10 children (8 HB, 2 HCC) treated with preoperative chemotherapy and in another 2 HB patients treated when they developed pulmonary metastases after initial treatment with surgery alone. There were 2 complete responses (2 HB with pulmonary recurrences), 7 very good partial responses (6 HB and 1 HCC), 2 partial responses (1 HB, 1 HCC), and 1 stable disease (HB). The last patient underwent orthotopic liver transplantation whereas all the other patients had their tumor completely excised at delayed surgery. Documented toxicity was BM depression (16 patients), infection (11), vomiting (11), mucositis (3), hearing loss (1), and cardiotoxicity (1). These data indicate that PLADO in continuous infusion is effective in the treatment of malignant epithelial liver tumors with acceptable toxicity.
Germ cell tumors in children: Gonadal and extragonadal
Authors: Wollner Norma , Ghavimi Fereshteh , Wachtel Antonio , Luks Enrique , Exelby Philip , Woodruff James
Published: February 2007

Sixty‐three pediatric patients with germ cell tumors are presented with details of symptoms, histological findings, staging, serological markers, treatment, and response to therapy. The primary sites were: ovarian 32, testicular 17, presacral 7, mediastinal 3, intraabdominal 2, vaginal 1, and right inguinal canal 1. These patients were treated with T2 (sequential use of dactinomycin, doxorubicin, vincristine, and cyclophosphamide, with or without radiation), T6 (combination chemotherapy with cyclo‐phosphamide, bleomycin, dactinomycin, doxorubicin, methotrexate, vincristine), or VAB treatment protocols (velban, dactinomycin, bleomycin, cisplatin). The cure rate for stage I ovarian and testicular germ cell tumors was 100%; for stage III, all primary sites, 82% and for stage IV, all primary sites, 75%. Histology was prognostic in ovarian tumors of the immature malignant teratoma type; the neural type immature teratoma, grades II and III, had the worst prognosis. Initial debulking surgery in combination with chemotherapy and radiation plays an important role in germ cell tumors. Stages II, III, and IV germ cell tumors require aggressive treatment with surgery, radiation, and chemotherapy. For stage I patients, with primary ovarian malignant tumor, cure with surgery alone can be achieved in 50% of the cases and in testicular tumors in about 70% of the patients. For those with stage I and elevated serological markers, it is feasible to follow these markers and give no treatment until there is evidence of persistent elevation or a rise in titers after an initial fall. In those without elevated serological markers, one should take into consideration the size of the tumor and the histological type before taking the “wait and see” approach. These stage I tumors are highly curable when they first present but, if allowed to recur, chemotherapy may not offer the patient such a favorable response and cure rate.
Late orthopedic effects in children with Wilms' tumor treated with abdominal irradiation
Authors: Rate William R. , Butler Mark S. , Robertson William W. , D'Angio Giulio J.
Published: February 2007

Between 1970 and 1984, 31 children with biopsy‐proven Wilms' tumor received nephrectomy, chemotherapy, and abdominal irradiation and were followed beyond skeletal maturity. Three patients (10%) developed late orthopedic abnormalities requiring intervention. Ten children received orthovoltage irradiation, and all cases requiring orthopedic intervention or developing a scoliotic curve of >20d̀ were confined to this group, for a complication frequency of 50%. Those children who developed a significant late orthopedic abnormality (SLOA) as defined were treated to a higher median dose (2,890 cGy) and a larger field size (150 cm2) than those who did not (2,580 cGy and 120 cm2). Age at irradiation, sex, and initial stage of disease did not appear to influence the risk of developing an SLOA. No child who received megavoltage irradiation developed an SLOA despite treatment up to 4,000 cGy or to field sizes of 400 cm2. We conclude that modern radiotherapy techniques rarely lead to significant late orthopedic abnormalities previously associated with abdominal irradiation in children with Wilms' tumor.
Trimetrexate in untreated and previously treated patients with metastatic breast cancer: A cancer and leukemia group b study
Authors: Dawson Nancy A. , Costanza Mary E. , Korzun Ann H. , Clamon Gerald H. , Pollak Michael , Vogelzang Nicholas J. , Carey Robert W. , Norton Larry
Published: February 2007

Twenty‐two patients with previously untreated metastatic breast cancer and nineteen patients with refractory metastatic breast cancer were treated with trimetrexate (TMTX). Patients received TMTX 8 mg/m2/day if previously treated or 12 mg/m2/day if previously untreated, both given by intravenous bolus days 1–5, every 21 days. None of the patients previously treated for metastatic disease responded to TMTX. There was one partial responder among the 22 patients with previously untreated metastatic disease. The primary toxicity was hematologic and occurred more frequently in patients with a pleural effusion, low serum protein or albumin, or poor performance status. There were three toxic deaths. The study for previously untreated patients required cyclo‐phosphamide, doxorubicin, and 5‐fluorouracil (CAF) after 4 cycles of TMTX. This study design for previously untreated patients allows the Cancer and Leukemia Group B (CALGB) to prospectively evaluate the activity of new agents in “chemotherapy‐sensitive” metastatic breast cancer.
Percutaneous lumbar intrathecal catheter for the administration of chemotherapy
Authors: Tobias Joseph D. , Oakes Linda , Foreman Nicholas K. , Mahmoud Hazem
Published: February 2007

We present a patient with Burkitt's lymphoma in whom the initial diagnostic lumbar puncture was difficult due to a recent lumbar laminectomy and residual spinal cord tumor. According to our current protocol, he was to receive intrathecal chemotherapy for three consecutive days. To avoid the need for repeated attempts at lumbar puncture and to ensure the proper instillation of therapy, a percutaneous IT catheter was placed for 48 hours and the three doses of IT chemotherapy were administered through this catheter. Due to the importance of IT chemotherapy, options must be available to deliver these medications when technical or anatomic abnormalities exist. One such option is the short term placement of a percutaneous IT catheter.
Osteoblastic metastases from astrocytomas: A report of two cases
Authors: Longee Darryl C. , Friedman Henry S. , Phillips Peter C. , Burger Peter C. , Oakes W. Jerry , Heffez Dan , Wharam Moody , Strauss Lewis , Fuller Gregory N. , Schold S. Clifford
Published: February 2007

The spread of primary central nervous system (CNS) neoplasms beyond the confines of the neuraxis is a relatively uncommon observation. Extraneural metastases involving bone are quite rare, and have been observed almost exclusively in cases of medulloblastoma, high‐grade (III‐IV) astrocytoma, and glioblastoma multiforme. To date there has been only one case reported of bone metastasis from a “well‐differentiated” astrocytoma. We now report two cases of astrocytoma in children with diffuse osteoblastic metastases and a fulminant clinical course. These cases demonstrate that due to the potential morphologic heterogeneity of these neoplasms, an initial biopsy diagnosis of low‐grade astrocytoma does not always imply a benign clinical course.
Malignant peritoneal mesothelioma: Long‐term spontaneous clinical remission
Authors: Schwartz Eliezer , Maayan Chaim , Mouallem Meir , Engelberg Santiago , Friedman Eitan
Published: February 2007

Prolonged spontaneous clinical remission in a patient with malignant peritoneal mesothelioma is described. The case is also unique because of the presence of highspiking fevers as a symptom of tumor recurrence and the finding of an elevated titer of rheumatoid factor in the ascitic fluid. The caution needed in interpreting results of therapeutic interventions in this tumor is emphasized.
Treatment of stage IV‐S neuroblastoma: A study of 34 cases treated between 1982 and 1987
Authors: Suarez Alcira , Hartmann Olivier , Vassal Gilles , Giron Alain , Habrand Jean Louis , Valteau Dominique , Brugieres Laurence , Kalifa Chantal , Lemerle Jean
Published: February 2007

Between January 1982 and December 1987, of 283 children with neuroblastoma treated in the Pediatric Department of Institut Gustave Roussy, 34 were stage IV‐S. Two groups were distinguished according to the initial clinical presentation: 16/34 patients had life‐threatening symptoms and needed immediate treatment, and 18/34 had no life‐threatening symptoms. Hepatic irradiation was used in 12/16 patients of the first group with respiratory distress. Chemotherapy was used in three patients. Of these 16 patients, three patients died of progressive disease (one patient died of a reason not related to the tumor). Twelve are alive in first complete remission and one in second complete remission. Of the 18, patients of the second group, eight had spontaneous complete remission, and one of them relapsed thereafter and died despite treatment. Ten patients needed treatment, radiotherapy, and/or chemotherapy depending on the site of disease progression. Two of them died of the disease. The overall disease‐free survival for these 34 patients is 75% at 90 months postdiagnosis. Using this therapeutic strategy, it was possible to avoid any treatment of metastases in 25% of the patients.