bluuebunny/crossref_metadata_2025 huggingface dataset:
Chemoimmunotherapy of sarcomatoid renal cell carcinoma
Authors: Krutchik Allan N. , Sullivan Charles , Sinkovics Joseph G. , Ayala Alberto
Published: February 2007

Sarcomatoid renal adenocarcinomas are rare, invariably fatal tumors. There is only one report of treatment of this tumor with chemotherapy. We report a case of an advanced sarcomatoid renal adenocarcinoma treated with chemo‐immunotherapy consisting of cyclophosphamide, vincristine, Adriamycin (doxorubicin), DTIC, BCG, and sarcoma viral oncolysate. The patient had an objective response with a marked reduction in the size of the tumor mass. The residual tumor was removed surgically, and the patient remains in complete remission two years after the diagnosis was made.
The lack of correlation of gallium (67Ga) scans with known prognostic indicators in childhood acute lymphocytic leukemia
Authors: Zuraw Margaret S. , Ko Benjamin , Siddiqui Aslam , Weetman Robert M. , Baehner Robert L.
Published: February 2007

67Gallium‐citrate scans were performed on 45 patients with acute lymphoblastic leukemia (ALL) at the time of diagnosis. The extent of uptake and distribution of gallium were compared to known prognostic indicators of age, initial white count, and bone marrow lymphoblast immune markers (T, B, and null cell). Selective increased uptake was noted in bone, kidney, liver/spleen, lymph nodes, or other sites in 29 patients, and 16 patients had “normal” scans. A scoring system giving one point for selective uptake in each organ system was used. Patients were grouped according to scores of zero, 1–2, and 3 or greater. There was no significant correlation found between total gallium scores and any of the three prognostic indicators. There was also no significant correlation when prognostic factors were compared to uptake in the individual organ systems except that T cell disease was associated with a significantly greater propensity for lymph node uptake. There was a suggestion that children with “normal” gallium scans may have a better long‐term prognosis, since 6 of 7 nonrelapsers observed for longer than 18 months had scores of zero at diagnosis compared to 4 of 6 early deaths with scores greater than zero. This study indicates that the 67Ga scan does not significantly correlate with known prognostic indicators, with the possible exception of lymph node uptake in T cell disease, and its value as an independent indicator of long‐term survival will require longer follow‐up.
Metastatic ewing sarcoma to the heart simulating adriamycin cardiotoxicity
Authors: Raafat Jahangir , Brown James A. , Oster Martin W.
Published: February 2007

A 20‐year‐old man with metastatic Ewing Sarcoma developed severe congestive heart failure. Because he had been treated with a large amount of Adriamycin, the diagnosis was initially thought to be Adriamycin cardiotoxicity. However, ante‐ and post‐mortem studies revealed the presence of massive cardiac metastases. At post‐mortem, there was no evidence of Adriamycin cardiotoxicity. This case emphasizes that cardiac metastases must be consideredin the differential diagnosis of heart failure in patients treated with Adriamycin.
Safety of delayed leucovorin “rescue” following high‐dose methotrexate in children
Authors: Camitta Bruce M. , Holcenberg John S.
Published: February 2007

High‐dose methotrexate (HDMTX) with leucovorin (CF) “rescue” is being investigated for treatment of many malignant tumors. CF is usually begun 2 hours after ending the HDMTX infusion. However, since CF and methotrexate compete for the same cellular transport system, at high extracellular methotrexate concentrations it may be impossible to “rescue” cells with CF. A regimen of HDMTX with delayed leucovorin “rescue” was therefore designed. In this program, a 6‐hour infusion of methotrexate (7.5 gm/m2) was followed 24 hours later by leucovorin “rescue.” Nine patients with osteogenic sarcoma received 115 courses of this treatment. Toxicity was minimal. Plasma methotrexate values were identical to those following early CF “rescue” regimens.

HDMTX with delayed “rescue” is well tolerated. Although theoretically sound, further studies are needed to determine its efficacy in comparison to standard early “rescue” regimens.
Electrocardiographic changes following adriamycin treatment
Authors: Dindogru Aydin , Barcos Maurice , Henderson Edward S. , Wallace H. James
Published: February 2007

Two hundred and fifty‐six patients with a wide variety of advanced neoplasms who were treated with adriamycin at Roswell Park Memorial Institute were studied for electrocardiographic changes. All the patients had pre‐ and posttreatment electrocardiograms (ECG's) and changes were found in 85 (33.2%). In the group of 168 patients with normal pretreatment ECG's, changes occurred in 51 (30.3%). In the group of 88 patients who had abnormal pretreatment ECG's, 34 (38.6%) developed further changes following treatment. Twenty‐five patients received cytoxan concomitantly and ECG changes developed in 12 (48%); however, this and the above differences were not statistically significant. Frequency of ECG changes was higher and the extent of histologic abnormality in the myocardium was greater in those patients who received high doses of adriamycin. Arrythmias were rather benign and only a small number of patients required treatment. ECG changes following adriamycin treatment occurred more frequently than previously reported.
Malignant lymphoma associated with marked eosinophilia
Authors: Bennett Allen , Bennett Leslie , Rosner Fred , Korman Samuel
Published: February 2007

A 60‐year‐old black man with poorly differentiated lymphocytic lymphoma presented with generalized lymphadenopathy and marked eosinophilia. Extensive evaluation of the eosinophils revealed them to be normal morphologically and functionally. The patient responded to corticosteroid therapy with resolution of the lymphadenopathy and reversion of the peripheral blood counts to normal limits. Recurrence of the original clinical picture within months prompted institution of systemic chemotherapy. Response was transient, and the patient expired after an unremitting downhill course. Recent advances in our knowledge of mechanisms of eosinophilia and eosinophil function are reviewed. The relationship of lymphoma to eosinophilia is discussed.
High‐dose methotrexate for the remission induction of refractory adult acute lymphocytic leukemia
Authors: Peterson Bruce A. , Bloomfield Clara D.
Published: February 2007

Six adults with refractory acute lymphocytic leukemia (ALL) were treated with high‐dose methotrexate, citrovorum factor, and vincristine. All patients had previously received extensive treatment with standard therapeutic agents, including vincristine, and all but one had received prior methotrexate. Two patients achieved complete remission and one achieved partial remission. Responses were seen at 3–6 gm/m2 of methotrexate. The durations of remission were 7–10 weeks. High‐dose methotrexate with citrovorum factor is effective in the treatment of advanced ALL and should be considered for inclusion in initial combination chemotherapeutic regimens for adult ALL.
The effects of prior exposure to bleomycin on the incidence of pulmonary toxicities in a group of patients with disseminated testicular carcinomas
Authors: Crooke Stanley T. , Einhorn Lawrence H. , Comis Robert L. , D'Aoust Joan C. , Prestayko Archie W.
Published: February 2007

The incidence of pulmonary toxicities in 12 patients with prior exposure to bleomycin (BLM) was compared to the incidence of pulmonary toxicities in a matched group of 73 patients with stage III or IV testicular carcinomas treated with a regimen containing vinblastine, bleomycin, and cis‐diamminedichloroplatinum. The comparison demonstrates that prior exposure to bleomycin constitutes a significant risk factor and that the risk is additive; ie, prior doses should be added to current doses to determine the cumulative dose‐related probability of development of pulmonary toxicities.
Resistance of human tumors to cancer chemotherapeutic agents: An important research problem
Authors: Bertino J. R.
Published: February 2007

The mechanisms whereby malignant cells become biochemically resistant to anti‐cancer drugs are surveyed, with emphasis on human tumors. Metho‐trexate is used as a model to illustrate the mechanisms of resistance that can occur, and how cells can increase their production of dihyrofolate reductase, the target enzyme. Drug resistance remains one of the major impediments to the successful use of chemotherapy for neoplastic diseases.
Nephroblastoma (Wilms tumor): Tubule density and prognosis
Authors: Chambers C. H. , Camitta B. M. , Garg U. , Tang T. T. , McCreadie S. R.
Published: February 2007

Relative differences in tubule density of the primary tumors have been suggested to be prognostically useful in nephroblastoma (Wilms tumor). Forty cases from our institution were retrospectively graded according to tubule density. There were significant differences in disease‐free survivals between histologic grades. When compared to other clinical and pathologic staging criteria, tubule density was not more useful prognostically than the staging systems tested. However, when used in conjunction with clinical or pathologic stage, tumor grade improved prognostic sensitivity. Regardless of grade or stage, patients less than 24‐months‐old at diagnosis had better disease‐free survival.
Steroid receptors study in breast carcinoma
Authors: Lee Yeu‐Tsu N. , Markland Francis S.
Published: February 2007

Estrogen receptors (ER) were measured on specimens taken from 27 patients with benign breast conditions and 109 patients with breast cancer. Using sucrose gradient assay, 15% (4/27) of benign lesions and 56% (61/109) of malignant tumors were estrogen receptor‐positive (ER‐positive means 8S or 8S+4S levels more than 7 fmoles/mg cytosol protein). Progesterone receptors (PR) were tested on specimens from 28 patients and 39% (10/26) of the cancers were PR‐positive. ER protein activity was not correlated with stage, histology, size of primary lesions, or extent of axillary or distant metastasis. Tumors with low ER levels are more likely to recur, and recurrent tumors after longer disease‐free intervals are more likely to be ER‐positive. Detailed analysis showed that ER levels did correlate with age and serum albumin levels. Concentrations of serum α1‐globulin were decreased, while IgG and IgM were significantly increased among patients with positive ERs. Eighteen evaluable patients with advanced breast cancer had endocrine therapy, 13 had objective response. Twelve of these 13 had 8S receptor above 10 fmoles/mg, or 4S above 15 moles/mg, or 8S+4S above 25 fmoles/mg. The one exceptional patient had tumor with high PR but without detectable ER.
Cytokinetic studies in children with untreated acute lymphocytic leukaemia (ALL): Relationship to “T” cell markers
Authors: Ekert H. , Dobrostanski B. , Jose D. G. , Waters K. D. , Ellis W. M.
Published: February 2007

The labelling index (LI), mitotic index (MI) of marrow lymphoblasts and the percent of peripheral blood lymphocytes and lymphoblasts that form rosettes with sheep red cells at 4°C (“T4”), were measured at presentation in 33 children with ALL. There was a significant correlation between LI and MI, but no significant correlations between them and the total white cell count at diagnosis or the “T4” percent. Three patients had > 55% “T4” rosettes and showed increased LI and MI, and 2 have relapsed; 12 had < 20% “T4” rosettes, showed an increased LI (LI > 8% in 8 of 12) but not MI, and 5 have relapsed; 18 had 20–55% “T4” rosettes and generally had the lowest LI (LI < 8% in 11 of 18), and only 3 have relapsed. Our findings suggest that patients with high and low percentage of “T4” rosettes in the peripheral blood have an increased fraction of leukaemic cells in DNA synthesis and have a diminished chance of prolonged remission.
Characteristics of long‐term survivors in AML
Authors: Oliff Allen , Poplack David
Published: February 2007

We examined the records of all patients with a diagnosis of acute myelogenous leukemia or acute myelo‐monocytic leukemia seen between 1963–1975. Of 211 patients, 12 are alive and in complete remission from 179‐48 months since diagnosis. Life table analysis reveals a survival plateau of 4–5% after five years. Three of the survivors have suffered relapses but still survive without evidence of disease. The clinical and laboratory characteristics of all the survivors are presented. The survivors have a significantly younger age at diagnosis than the nonsurvivors (P < 0.005). However, no other factors could be identified as characteristic of the survivors' group.
4‐aminoimidazole‐5‐carboxamide excretion in acute leukemia
Authors: Johnson Helen , Lapin Charles
Published: February 2007

The urinary excretion of 4‐aminimidazole‐5‐carboxamide (AIC) has been reported to be increased in children with acute leukemia and has been correlated with disease status. Using a modification of the method of Skibba et al [5], determinations were made on urine from 26 children with acute leukemia. The urine from ten normal children served as controls. The effect of chemotherapy on urinary AIC was studied comparing patients on vincristine and prednisone (V+P) with those on 6‐mercaptopurine, methotrexate, and cyclophosphamide (Triple Rx). Patients in remission on Triple Rx had lower levels of urinary AIC than did patients on Triple Rx in relapse or patients on V+ P in either remission or relapse. Twenty patients had sequential measurements. Values for individual patients were not predictive of disease status. One such patient is described. This study demonstrates that chemotherapy, as well as disease status, affects the urinary excretion of AIC in children with acute leukemia.
EST 0469B—comparison of high‐ and low‐dose cyclophosphamide in human lung cancer
Authors: Hall Thomas C. , Pocock Stuart , Brodovsky Harvey , Horton John , Shnider Bruce I. , Colsky Jacob , Oberfield Richard A.
Published: February 2007

A controlled trial of high‐intermittent vs low‐chronic dose cyclophosphamide in human lung cancer failed to show the benefits reported in noncontrolled trials. There were no differences in toxicity observed.
Increasing incidence of gram‐positive sepsis in cancer patients
Authors: Pizzo P. A. , Ladisch S. , Simon R. M. , Gill F. , Levine A. S.
Published: February 2007

A review of the agents causing septicemia in cancer patients during a nine‐year period (1968–76) revealed that gram‐positive organisms (especially S aureus) have become the most frequent isolates during the last two years. This unanticipated increase (P < 0.001) in the number of gram‐positive isolates could not be related to horizontal transmission nor to changes in patient characteristics or therapy.
The effect of methanol extraction residue of BCG on the cellular immune response in patients with malignant melanoma
Authors: Bartal Arie , Cohen Yoram , Mekori Tamar , Haasz Robert , Robinson E.
Published: February 2007

Twenty‐one patients with malignant melanoma stage III and IV were treated by intradermal injections of MER ‐ methanol extraction residue of Baccillus Calmette‐Gurin (BCG). Twelve of the patients, all with active disease, received chemotherapy in addition. Tests of skin reactivity to recall antigens and in vitro lymphocyte transformation by phytohemagglutinin (PHA), purified protein derivative (PPD), Canadidine, and Varidase were performed in 19 of the patients before and after the MER therapy. The skin reactivity improved in 8 patients, 5 patients maintained their cutaneous competence, 3 remained incompetent, and in 3 other patients a decrease in reactivity occurred. Improvement or maintenance of cutaneous response was more common in stage III than in stage IV patients. The in vitro lymphocyte stimulation tests have shown that reactivity increased or remained at a high level in 9 of 11 patients in stage III. It dropped or remained low in 2 patients in respect to all antigens used in spite of repeated MER injections. In most patients with stage IV disease no improvement could be detected. MER seems to be a potent immunostimulator in patients in stage III. The side effects were tolerable in all patients and consisted of local reactions and influenza‐like symptoms. In 4 patients treated with MER by intralesional injections, transiet flattening of nodules occurred but no complete regression was observed.
Combination chemotherapy for non‐Hodgkin lymphomas: A ten year follow‐up study
Authors: Hayes Donald M. , Pajak Thomas F. , Rege Vishram , Falkson Geoffrey , Spurr Charles L. , Silver Richard T. , Nissen Nis I. , Harley John B. , Cuttner Janet , Glidewell Oliver , Holland James F.
Published: February 2007

In 1968 the Cancer and Acute Leukemia Group B (CALGB) demonstrated optimal control of disseminated non‐Hodgkin lymphomas (NHL) with vincristine‐prednisone induction followed by cyclophosphamide maintenance. A study was then begun to determine whether four drugs in combination or sequence could achieve greater control. NHL patients at each participating CALGB institution were randomly assigned to one of three regimens: I) Cyclic vincristine‐streptonigrin alternating every 2 weeks with cyclophosphamide‐prednisone up to 155 days; II) Sequential treatment with the same 4 drugs taken singly up to 182 days; and III) Vincristine‐prednisone induction for 6 weeks followed by cyclophosphamide maintenance. Results are now reported after a 10 year follow‐up period. The 203 evaluable patients are those on whom Rappaport histopathologic classification was available. Frequency of complete response did not differ significantly among the three regimens: I) 38%; II) 30%; and III) 45%. Remission durations were significantly longer among patients receiving maintenance therapy. After ten years, two patients from Regimen I, one from Regimen II, and five from Regimen III remain alive and well. It was concluded that neither of the four‐drug regimens conferred a significant advantage in terms of response rate or survival time over the standard treatment.
Thirty‐six‐hour preoperative high‐dose methotrexate infusion in patients with squamous carcinoma of the head and neck
Authors: Hande K. R. , Chretien P. B. , Elias E. G. , Goldberg N. H. , Brooks A. E. , Chabner B. A.
Published: February 2007

Twenty 36‐hour infusions of high‐dose methotrexate were given preoperatively to 10 patients with head and neck cancer. Plasma methotrexate levels of greater than 1 × 10−5 M were maintained for 36 hours and declined with primary and secondary plasma half‐lives of 1.7 and 9.2 hours following the end of the infusion. Toxicity of this infusion regimen was minimal (10% incidence of significant (WBC <2000/mm3) myelosuppression; no renal toxicity) and all patients underwent surgical resection within 3 weeks of therapy without obvious increase in operative complications. Four of ten patients responded to chemotherapy. Further comparison of the therapeutic efficacy of this prolonged preoperative infusion regimen with surgery alone or schedules employing conventional doses or 6‐hour infusions of high‐dose methotrexate appears warranted.
Bone marrow biopsy in children: A study of 111 patients
Authors: Cozzutto C. , de Bernardi B. , Comelli A. , Guarino M.
Published: February 2007

Closed trephine needle biopsy of the bone marrow has become an established procedure in the evaluation of many malignant and benign diseases in adults; however, its role in pediatric pathology has not yet been defined.

In the period from February 1974 to April 1978 we have performed 164 such biopsies in 111 children under 15 years of age. A representative specimen has been obtained in over 80% of cases. This series included, in order of frequency, non‐Hodgkin lymphomas, Hodgkin lymphomas, aplastic anemias, rhabdomyosarcomas, neuroblastomas, miscellaneous solid tumors, and single cases of histiocytosis X, malignant histiocytosis, sarcoidosis, malignant histiocytoma, and Castleman lymphoma of the hyaline‐vascular type.

Histology has been found superior to cytology in the detection of neuroblastoma invasion; the evaluation of the true cellularity in aplastic anemia, and the detection of granulomatous tissue in the only case of sarcoidosis. In other diseases histology and cytology gave similar information, except for the few cases of acute leukemia in partial relapse, which has been better defined in the aspirate smears than in the core specimen.

Further evaluation of this technique in other patient series appears advisable.
Granulocyte transfusions in infected neutropenic children with malignancies
Authors: Steinherz Peter G. , Reich Lilian M.
Published: February 2007

Thirty‐six febrile neutropenic episodes were treated by granulocyte transfusions in 33 children. Septicemia and mucous membrane ulcerations were most commonly associated with the fever. Infection cleared in 81% of the episodes, eight per cent ended in death from bacterial infections, 11% from nonbacterial infections or hemorrhage. The median number of polymorphonuclear leukocytes given was 1.1 × 1010/m2/transfusion. Two to twenty‐eight (median 8.5) transfusions were given over 3–34 days (median 10.5). The source of cells (parental or random) and the method of collection did not seem to affect the outcome. None of the 23 patients whose marrow recovered during the transfusions died of bacterial infections. Infection cleared even without marrow recovery in 62% of the patients, but then only 25% lived for more than two months after clearing of sepsis. In a subgroup of patients with nonlymphoblastic leukemia on the same chemotherapy and antibiotic treatment protocol, 8/11 (73%) survived bacteremia when white cell support was available; only 2/11 (18%) of a historical control group survived when such support was not available. Granulocyte support appears to be a valuable tool in helping neutropenic patients overcome their infections or, at the very least, helping them survive long enough for normal marrow recovery to occur.
Role of peritoneoscopy in the postoperative evaluation and treatment of adenocarcinoma of the exocrine pancreas
Authors: Bender Richard A. , Brereton Harmar D.
Published: February 2007

Our experience with peritoneoscopy in the postoperative staging and evaluation of ten patients with locally unresectable adenocarcinoma of the exocrine pancreas is presented. In contrast to the German experience with previously unexplored patients, the pancreas was visualized only 30% of the time and biopsy was not possible for technical reasons. Based on our experience in these ten patients, postoperative peritoneoscopy for staging or for following the effectiveness of treatment is of limited value in carcinoma of the pancreas. Preoperative evaluation of this technique deserves greater attention.
Abnormal lymphocyte function in childhood leukemia
Authors: Zusman Jaime , Nesbit Mark E.
Published: February 2007

Lymphocyte function was evaluated in 26 untreated children with acute lymphoblastic leukemia (ALL) and 5 patients with acute myelogenous leukemia (AML) by stimulation with phytohemagglutinin (PHA) in dose‐ and time‐response studies. The response to PHA correlated positively with the percentage of lymphocytes (r = + 0.786) and negatively with the percentage of lymphoblasts (r = − 0.728).

Sixteen patients with a WBC < 20,000/cu mm (51 ± 5% lymphocytes, 28 ± 7% lymphoblasts, and 39 ± 20% T cells) responded normally (81,156 ± 8,229 cpm) on the fourth or fifth day of culture. Ten patients with a WBC > 20,000/cu mm (10 ± 3% lymphocytes, 88 ± 4% lymphoblasts and 18 ± 28% T cells) had a significantly lower response to PHA on these days (13,609 ± 5,568 cpm).

Six of the ten high‐WBC patients had a delayed peak response on the sixth or seventh day of culture. This abnormal response to PHA is similar to that which has been described in patients with chronic lymphatic leukemia and is at least partially due to the dilution of a normal lymphocyte population by the proliferation of a population of non‐PHA‐responsive lymphoblasts.

The remaining four high‐WBC patients had flat PHA dose‐ and time‐response curves and a poorer clinical course. Two of them had T‐cell leukemia. The absence of response to PHA in these children may characterize a group of patients with acute lymphoblastic leukemia who are immunodeficient at the time of diagnosis and may reflect the presence of a unique population of lymphoblasts with suppressor activity.
The prognostic value of serum lysozyme activity in acute myelogenous leukemia
Authors: Alsabti Elias
Published: February 2007

Serum lysozyme activity was measured in samples from adult patients with acute leukemia, malignant tumors, and in normal adults. Twenty‐eight adult patients with acute myelogenous leukemia (AML) had significantly elevated levels of lysozyme at diagnosis, and none of the adults fell within the normal range. Thirty‐two patients with AML in complete remission had lysozyme levels comparable to normal adults, whereas patients with AML in relapse (eight cases) also had abnormally high levels of lysozyme activity. Ten patients with AML in remission and off therapy also had normal lysozyme levels. Three patients with acute lymphatic leukemia had normal lysozyme levels, while one child with monomyelocytic leukemia had substantially elevated lysozyme levels before treatment. It seems that in patients in remission and with normal blood values, the serum lysozyme activity is valuable for monitoring the remission.
Naked megakaryocyte nuclei revisited
Authors: Spanos George , Kalra Jagmohan , Rosner Fred
Published: February 2007

Bone marrow smears from 35 patients with various neoplasms and from 32 control patients were examined for the presence and percentage of naked megakaryocyte nuclei (NMN). The percentages of NMN in the two groups did not significantly differ. We conclude that the enumeration of NMN is of no value as a diagnostic test of malignancy.
Pulmonary toxicity from carmustine (BCNU): A case report
Authors: Weiss Raymond B. , Shah Sheila , Shane Stanley R.
Published: February 2007

A patient who had a pneumonectomy for lung carcinoma was treated with carmustine when brain metastases developed. His pulmonary function was mildly compromised prior to the pneumonectomy by many years of smoking. After six months of carmustine therapy [total dose: 2,250 mg (1,200 mg/m2)] he developed interstitial pulmonary fibrosis with histologic changes consistent with drug toxicity. With seven previously reported cases of this drug effect and the addition of our case, carmustine must be added to the list of cancer chemotherapeutic agents that can cause pulmonary toxicity.
A study of transfer factor for opportunistic infections in cancer patients
Authors: Ketchel Steven J. , Rodriguez Victorio , Stone Anita , Gutterman Jordan U.
Published: February 2007

Although supportive care during therapy of patients with malignancies has improved, infection remains the major cause of death in these patients. The problem of „opportunistic”︁ infections is becoming more apparent as better antibiotics are found. The control of these infections depends in part on mechanisms of cell‐mediated immunity. It has been demonstrated that delayed‐type hypersensitivity can be transferred from one person to another. Therefore, we used transfer factor in the treatment of 15 patients, most with leukemia, who had fungal, viral, or mycobacterial infections that were not responding to conventional therapy. Seven of ten evaluable patients had therapeutic control of their infections while receiving transfer factor. Transfer factor appears to have contributed to these clinical improvements and is a modality of treatment that deserves further investigation.
Vincristine and prednisone vs vincristine, l‐asparaginase, and prednisone for second remission induction of acute lymphocytic leukemia in children
Authors: Herson Jay , Starling Kenneth A. , Dyment Paul G. , Humphrey G. Bennett , Pullen Jeanette , Vats Tribhawan
Published: February 2007

Second remission induction rates for vincristine and prednisone alone (VP) and vincristine, L‐asparaginase, and prednisone (VLP) are compared for children with acute lymphocytic leukemia. No evidence of a significant difference between the second induction complete remission rate for VP (78.6%) and VLP (73.7%) was found. Duration of first remission and prognostic group at initial diagnosis (defined on the basis of age and white blood count at initial diagnosis) are shown to be significant prognostic factors for second remission induction; and three second remission induction risk groups are defined on the basis of these two factors. Periodic reinforcement with prednisone in first remission does not appear to lower second induction complete response (CR) rates for VP. There was no evidence of a significant difference in the frequency of occurrence of severe toxicity between the VP and VLP regimens.
Leukemic phase of malignant histiocytosis (arguments in favour of the histiomonocytic origin of the abnormal cells)
Authors: Harousseau J. L. , Degos L. , Daniel M. T. , Flandrin G.
Published: February 2007

A 15‐year‐old female was treated for malignant histiocytosis. The occurrence of a leukemic phase (178,000 blasts/cu mm) during the follow up provided the opportunity of studying a large number of malignant cells by cytochemical, electron microscopic, and cell membrane markers techniques. Acid phosphatase reaction was strongly positive and totally inhibited by tartaric acid. Nonspecific esterase reaction was moderately positive with inhibition by sodium fluorid. Electron microscopy revealed the presence of surface membrane pseudopods and the phagocytic activity of the cells. The leukemic cells had a receptor for the Fc fragment of IgG. These findings support the histiomonocytic origin of the abnormal cells in malignant histiocytosis.
Combination chemotherapy for bone marrow relapse in childhood lymphoblastic leukaemia (all)
Authors: Chessells Judith M. , Cornbleet Michael
Published: February 2007

Thirty‐four children with acute lymphoblastic leukaemia (ALL) in relapse or resistant to initial induction received combination chemotherapy with prednisolone, vincristine, 1‐asparaginase, and daunorubicin. L‐asparaginase was given subcutaneously on alternate days for four weeks and was well tolerated. A complete remission was achieved in 96% of children in relapse and in five out of six children resistant to induction. Remission was achieved without hospitalisation in over 60% of patients.

The median duration of subsequent remission was only 13 weeks, but six out of eight children receiving a second course of the drug combination achieved a further remission. We conclude that prolonged 1‐asparaginase therapy in combination with an anthracycline might well be used in initial or consolidation therapy for childhood ALL.
Ewing sarcoma: Treatment with high dose radiation and adjuvant chemotherapy
Authors: Graham‐Pole John
Published: February 2007

Twenty‐one patients with pathologically proven Ewing sarcoma without overt metastases at diagnosis were treated with a protocol were treated with a protocol designed by the Royal Marsden/St. Bartholomew's Hospitals Children's Solid Tumour Group (CSTG). They received megavoltage radiotherapy to the involved bone and adjuvant chemotherapy with a combination of four cytotoxic drugs. Seven patients have so far relapsed, four at the original site and three in other bones. The other 14 are clinically free of disease a median of 36 months from diagnosis. Comparison with a historical control group of 19 patients treated with surgery or radiotherapy, but without initial chemotherapy, shows a significant improvement in survival for the study group (P = 0.03). Seventeen of the controls have died.

The treatment regime was moderately toxic, but there were no treatmentrelated deaths. These results confirm that an improved survival time and hopefully cure rate can be expected from treating Ewing tumour with high doses of megavoltage radiation and combination chemotherapy. Future goals must be the better control of large primary lesions and the eradication of micrometastases in other bones. The place of surgery should be re‐evaluated in the treatment of the primary tumour, and better adjuvant chemotherapy regimes are needed.
Chromosome 1 abnormalities in relapse and terminal stages in childhood leukemia
Authors: Morse Helvise , Hays Taru , Rose Barbara , Robinson Arthur
Published: February 2007

Seven of 114 children with leukemia were shown to have abnormalities of chromosome 1. These included trisomy of parts of chromosome 1 as well as translocations of chromosome 1 to other chromosomes. The abnormalities were found during a relapse or terminal stage, after which the patient was refractory to therapy in all cases.
Childhood leukemia and lymphoma: Correlation of clinical features with immunological and morphological studies
Authors: Quinn John J. , Taylor Clive R. , Swanson Virginia , Williams Arthur H. , Schneider Barbara K. , Higgins Gussie R. , Tindle Barbara H. , Powars Darleen , Lincoln Thomas , Chandor Stebbins B. , Pattenagle Paul , Siegel Stuart E. , Lukes Robert J.
Published: February 2007

Malignant cells from 49 children with lymphoid neoplasms other than Hodgkin disease were evaluated by surface marker and morphologic studies. We classified the patients into three groups: 36 patients (74%) with acute lymphocytic leukemia; 7 (14%) classified as convoluted lymphocytic lymphoma/leukemia; and 6 (12%) with small noncleaved follicular center cell lymphoma/leukemia; and 6 (12%) with small noncleaved follicular center cell lymphoma/leukemia. Diffuse marrow involvement was present at diagnosis in some patients in the latter two groups, but their clinical course was not characteristic of the patients with acute lymphocytic leukemia. Male predominance, poor prognosis, and high incidence of central nervous system disease characterized patients in the convoluted lymphocytic and follicular center cell lymphoma/leukemia groups. Clinical presentation in these two groups differed. Proliferations of convoluted lymphocytes were associated with mediastinal masses and proliferations of follicular center cells with intraabdominal tumors. The high incidence of CNS disease in children with neoplasms of convoluted lymphocytes and follicular center cells suggests that these processes have a predilection for the CNS and that patients with them may benefit from CNS prophylaxis.
Medical student training in medical oncology
Authors: Kennedy B. J.
Published: February 2007

The evaluation of a medical school course in Medical Oncology assessed the experience in which medical students act as interns. The direct involvement of the student as a physician in managing patients with cancer furthered the students' knowledge of cancer, improved their competency in dealing with patients with cancer and their families, and developed the students' insight and attitudes toward the problems of cancer.
Orbital rhabdomyosarcoma in a neonate
Authors: Harlow Paul J. , Kaufman Francine R. , Siegel Stuart E. , Quevedo Eduarita
Published: February 2007

A newborn with a pleomorphic rhabdomyosarcoma of the eyelid was treated by chemotherapy, surgery, and radiation therapy and experienced a good response. The nine previous cases in the literature are reviewed and this patient's therapy discussed.
Management of localized thoracic neuroblastoma
Authors: Castleberry R. P. , Crist William M. , Cain Walter S. , Holbrook Tate , Malluh Ahmad , Salter Merle M.
Published: February 2007

Thirteen children with localized (Evans stage I or II) thoracic primary neuroblastoma were divided into two groups according to the type of therapy administered, in order to compare the therapeutic efficacy and morbidity of excisional surgery followed by either irradiation alone or irradiation plus chemotherapy (group A) with similar surgery alone (group B). Group A consisted of 6 children (mean age 1 year, 2 months). Complete surgical excision was accomplished in 2 patients, while 4 had microscopic residual. All 6 patients are free of disease at 23–76 months (mean 47 months), including 2 who had recurrent tumor and received additional therapy. Two have developed congestive heart failure and one severe scoliosis secondary to irradiation.

Of the 7 children in group B (mean age 2 years, 2 months), 3 had microscopic residual tumor and 2 had adjacent lymph node involvement. After 12–47 months (mean 23 months), no recurrence or surgery‐related morbidity has been observed. From these limited data it appears that surgery alone may provide adequate therapy for localized thoracic neuroblastoma and obviate the morbidity associated with multimodal therapy.
Tumor lysis pancreatitis
Authors: Spiegel Robert J. , Magrath Ian T.
Published: February 2007

Rapid tumor lysis may produce acute complications including systemic metabolic disturbances and hemorrhage in sites involved by tumor. We have observed two cases of acute pancreatitis induced by the lysis of lymphoma that involved the pancreas. This previously unreported cause of pancreatitis must be added to the list of potential complications associated with effective cancer chemotherapy.
An unusual case of T‐cell lymphoproliferative disorder
Authors: Spanos George , Kanter Robert J. , Rosner Fred , Grünwald Hans W.
Published: February 2007

A 54‐year‐old woman with epigastric pain had leukocytosis of 73,000/μ1 consisting mainly of atypical lymphoid cells with convoluted and cleaved nuclei resembling Sézary cells; the bone marrow aspirate was nondiagnostic. Skin biopsy was unremarkable. The patient also had hypercalcemia and hemolysis with a positive direct Coombs' test, both of short duration.

The arterial oxygen tension was decreased, but there was no demonstrable lung pathology. The patient subsequently developed rapidly enlarging lymphadenopathy. Lymph node biopsy was interpreted as “undifferentiated pleomorphic lymphoma.” Immunologic functional studies revealed that the majority of the peripheral blood atypical lymphoid cells from involved lymph nodes formed rosettes with sheep erythrocytes.

The lymphadenopathy regressed transiently after the administration of chemotherapy and the white blood cell count decreased from a maximum of 385,000/μ1 to 3,500/μ1, at which point the arterial oxygen tension returned to normal. The unusual features of this patient are discussed in light of the known characteristics of the various types of T‐cell lymphoproliferative disorders.
Results of multimodal therapy for children with neurogenic sarcoma
Authors: Raney R. Beverly , Littman Philip , Jarrett Patricia , Waldman Maria T. G. , Chatten Jane
Published: February 2007

The courses of 18 children with neurogenic sarcoma (NS) treated at the Children's Hospital of Philadelphia between 1958 and 1979 were reviewed. Their median age was 11 years (range, 0.3–16 years); 12 were female and six male. Eleven children had stigmata of neurofibromatosis (NF). One patient had two separate tumors simultaneously. Nine of the tumors were primary in an extremity; six were intraabdominal, two craniofacial, and two truncal. Eleven of the 18 children had grossly complete surgical removal of the primary tumor, whereas seven had gross residual disease after surgery; none had distant metastases detected at diagnosis. The patients were divided into two groups according to whether treatment was primarily surgical (group A) or multimodal (group B). Treatment for group B patients included surgery, local radiotherapy, and multiple‐agent chemotherapy. Two of 12 patients (17%) treated primarily with surgery are surviving four and 14 years later with no evidence of recurrent disease (NED); both had complete removal of the primary NS. Two additional group A patients relapsed but were retrieved with radiotherapy and multiple‐agent chemotherapy. The other eight patients in group A died of tumor at a median of 14 months from diagnosis. In contrast, five of the six group B patients (83%) treated with adequate multimodal therapy (at least 4,000 rads local radiation plus vincristine, actinomycin D, and cyclophosphamide ± Adriamycin) are relapse‐free and surviving at a median of 27+ months from diagnosis. Nine of the 18 patients are free of disease, four with and five without NF. The results suggest that multimodal therapy similar to that for rhabdomyosarcoma should be used for children with neurogenic sarcoma.
Unusual cytogenetics in a case of acute lymphoblastic leukemia
Authors: Morse Helvise G. , Hays Taru , Odom Lorrie F.
Published: February 2007

The cytogenetics in the study of a patient with acute lymphoblastic leukemia are presented. Initially, a large proportion of both unstimulated and phytohemagglutinin (PHA)‐stimulated blood mitoses showed an abnormal karyo‐type with a 7;12 translocation and a trisomy 19. At the time of relapse, a PHA‐stimulated culture showed the clonal abnormality as well as dicentric chromosomes in normal cells, the latter possibly resulting from treatment.
Micrococcus luteus pneumonia: A case report and review of the literature
Authors: Souhami Luis , Feld Ronald , Tuffnell Peter G. , Feller Tamison
Published: February 2007

The clinical course of a 69‐year‐old male with acute myelogenous leukemia is described who, while extremely leukopenic (<100 neutrophils/μ1) from chemotherapy, developed a cavitating pneumonia due to a gram‐positive coccus, Micrococcus luteus. Aggressive antibiotic management and attainment of complete remission of his leukemia resulted in a successful outcome. A review of the literature regarding the pathogenicitiy of this organism and, in particular, its occurrence as a cause of pneumonia is presented.
Acute leukemia in pregnancy: Transient neonatal myelosuppression after combination chemotherapy in the mother
Authors: Okun David B. , Groncy Paula K. , Sieger Lance , Tanaka Kouichi R.
Published: February 2007

An 18‐year‐old primagravida received combination chemotherapy with vincristine, prednisone, L‐asparaginase, cyclophosphamide, daunomycin, 6‐mercaptopurine and central nervous system (CNS) prophylaxis with intrathecal methotrexate and whole‐brain irradiation for acute lymphoblastic leukemia (ALL) beginning in the 12th week of pregnancy. Therapy resulted in sustained complete remission of the leukemia and delivery of a normally developed female infant whose immediate neonatal course was complicated by transient severe bone marrow hypoplasia. Our experience confirms the reports of others that intensive chemotherapy can be administered in the last two trimsters of pregnancy without serious teratogenic complications. However, we conclude that such therapy may cause significant myelosuppression in the newborn.
Prostate cancer mimicking malignant lymphoma
Authors: Oster Martin W. , Wolff Marianne , Starrett Sheree
Published: February 2007

We report three patients evaluated on a medical service for lymphoma‐like signs and symptoms. Although none had prostate or bone symptomatology, all three were found to have metastatic prostate cancer. These cases emphasize the propensity of prostate cancer to metastasize to lymph nodes as well as bones. Diagnostic and therapeutic implications are discussed.
Hepatotoxicity in the treatment of acute lymphoblastic leukaemia
Authors: Topley J. M. , Benson J. , Squier M. V. , Chessells J. M.
Published: February 2007

Serial liver function tests and percutaneous liver biopsies were performed on 21 children receiving treatment for acute lymphoblastic leukaemia (ALL). The patients received continuing chemotherapy either with daily 6‐mercaptopurine and weekly methotrexate or with five‐day pulses of these drugs every three weeks.

Liver function tests were transiently abnormal in the majority of children, but the abnormalities bore no relationship to the histology of the liver biopsy. Mild inflammatory and fatty changes were commonly seen, and early portal fibrosis was found in three out of 16 patients biopsied at between 108–130 weeks on treatment. There was no correlation between treatment regime and results of biopsy. Three patients showed possible progression of abnormalities on repeat biopsy.

The risk of development of portal fibrosis appears low after 2–3 years of continuing chemotherapy, but examination of liver histology may be indicated if more prolonged therapy is contemplated.
Serum phosphodiesterase I activity in breast cancer patients
Authors: Bender John W.
Published: February 2007

Serum phosphodiesterase I (PDE I) activity was determined in 13 control and 51 breast‐cancer patients with various stages of disease. Patients with both localized and metastatic breast cancer had significantly elevated serum PDE I activity. The highest activity was seen in patients with liver metastases. A decline in serum PDE I activity was seen after surgical resection of all known disease.
Changes of CSF‐protein pattern in children with acute lymphoblastic leukemia during prophylactic cns therapy (Berlin protocol)
Authors: Siemes H. , Rating D. , Siegert M. , Hanefeld F. , Müller St. , Gadner H. , Riehm H.
Published: February 2007

The cerebral spinal fluid (CSF)‐protein profiles of ten children with previously untreated acute lymphoblastic leukemia (ALL) were investigated by agarose gel electrophoresis. The profiles were determined at diagnosis and during the fifth to eighth week of treatment when preventive therapy for central nervous system (CNS) leukemia (skull) irradiation, intrathecal methotrexate (ithMTX) was administered. The profiles were compared with those obtained from a control group of 67 children and those from 42 patients with acute aseptic meningitis. The data from the latter group demonstrated the CSF‐protein pattern of partial blood‐CSF barrier (B‐CSF‐B) breakdown. The children with ALL showed no or only minor signs of a B‐CSF‐B impairment at diagnosis and after four weeks of systemic treatment. However, CSF changes indicative of a lesion of the B‐CSF‐B increased in all children continuously during CNS prophylaxis. The protein profile at the end of combined chemotherapy and radiotherapy was very similar to that in patients with acute aseptic meningitis. These observations point to neurotoxic side effects on the CNS barrier system with the combination of cranial radiation and ithMTX. A striking finding was restricted heterogeneity of γ‐globulin, observed in the CSF of nine out of the ten children with ALL before or during treatment. The significance of this abnormality is unknown.
Successful chemotherapy for childhood metastatic embryonal cell carcinoma of the testicle: A preliminary report
Authors: Holbrook C. Tate , Crist William M. , Cain Walter , Bueschen Anton
Published: February 2007

A child with widespread metastases successfully treated with chemotherapy alone is described. One course of combination chemotherapy using cis‐platinum, vinblastine, and bleomycin produced disappearance of multiple pulmonary metastatic lesions. Four courses of therapy produced shrinkage and tumor sterilization of an abdominal mass. Twenty‐six months after initiation of chemotherapy the patient is well, off of all therapy for fourteen months, and free of disease or drug related complication with normal creatinine clearance and alpha‐fetoprotein determinations.

The published adult experience demonstrates that this therapy is extremely effective for the treatment of metastatic embryonal cell carcinoma of the testis in young adults, and our case report extends this favorable experience into childhood. Toxicity is substantial, but justifiable considering the poor outlook associated with widespread metastatic disease. Collectively, the reviewed data suggest that further trials of this type of therapy are indicated in children.
Delayed allergic reactions following intramuscular L‐asparaginase
Authors: Spiegel Robert J. , Echelberger Candyce K. , Poplack David G.
Published: February 2007

L‐asparaginase, a highly effective anti‐leukemic enzyme preparation, is now frequently being adminstered intramuscularly in order to decrease the incidence of severe sensitivity reactions. Although the occurrence of immediate hypersensitivity reactions and anaphylaxis has been diminished through this technique, we report three patients who developed delayed allergic reactions occurring hours after drug administration. This suggests that patients receiving L‐asparaginase intramuscularly merit prolonged observation periods beyond the usual one half to one hour.