bluuebunny/crossref_metadata_2025 huggingface dataset:
Bleomycin pulmonary toxicity: Its relationship to renal dysfunction
Authors: Dalgleish Angus G. , Woods Robert L. , Levi John A.
Published: February 2007

Two hundred seventy‐five patients who had received bleomycin were examined for evidence of pulmonary toxicity. Twenty‐six patients were diagnosed as having bleomycin pulmonary toxicity and, of these, 20 (77%) were documented as having renal dysfunction without other features recognized to be associated with the development of pulmonary toxicity. In this study renal dysfunction was a most important factor in the development of bleomycin pulmonary toxicity. As bleomycin is often administered with nephrotoxic drugs, it is suggested that renal function should be checked prior to each administration of bleomycin. It is proposed that appropriate dose modifications could significantly reduce the morbidity and mortality associated with bleomycin administration.
Cis‐platinum‐induced renal sodium wasting
Authors: Lammers Pamela J. , White Les , Ettinger Lawrence J.
Published: February 2007

A 10‐year‐old girl with a malignant ovarian germ cell tumor was treated with cis‐platinum‐based chemotherapy. During the thrid and fourth courses of therapy, the patient developed hyponatremia, hypomagnesemia, and hypocalcemia. Renal sodium wasting was documented to be the cause of the hyponatremia. Despite normalization of serum electrolytes, hyponatremia again occurred during a period of stress following cessation of cisplatinum. Prior work has documented that cis‐platinum‐induced hypomagnesemia is related to renal tubular dysfunction with resulting magnesium wasting. A similar etiology for cis‐platinum‐induced hyponatremia and renal sodium wasting is proposed.
The chemotherapy of granulosa cell tumors of the ovary: Experience of the wisconsin clinical cancer center
Authors: Neville Alan J. , Gilchrist Kennedy W. , Davis Thomas E.
Published: February 2007

We reviewed the clinical records of 32 patients with ganulosa cell tumor of the ovary treated at the Wisconsin Clinical Cancer Center (WCCC) between 1970 and 1982. Eleven of these patients were treated with one or more chemotherapeutic regimens, yielding a total of 22 treatment trials. Objective response was observed in 7 of 17 evaluable treatment trials (41%). The response to chemotherapy could not be assessed in five treatment trials due to the concomitant administration of radiotherapy. We conclude that granulosa cell tumor of the ovary is responsive to chemotherapy. However, the optimal chemotherapeutic regimen for this rare neoplasm remains to be established on the basis of prospective clinical trials.
Comparison of morphology in ALL at presentation and relapse
Authors: Lanham Gary R. , Rivera Gaston , Weiss Karen , Stass Sanford A.
Published: February 2007

A high frequency of conversion from L1 to L2 morphology in ALL at relapse has been reported in studies made without benefit of the French‐American‐British (FAB) scoring system. We compared the lymphoblast morphology at presentation and first hematologic relapse for 50 consecutive children with acute lymphoblastic leukemia using the FAB scoring system to determine the frequency of morphologic conversion. Forty‐eight patients presented with L1 morphology, 42 of whom (88%) relapsed with L1 blasts, four (8%) with L2 blasts, and two (4%) with blasts intermediate between L1 and L2. Two presented with L2 morphology, both relapsing with L2 blasts. These data do not support previous findings of a high frequency of conversion from L1 to L2 at relapse. They suggest, instead, that L2 morphology is not a common morphologic expression of initial treatment failure.
Height of children successfully treated for acute lymphoblastic leukemia: A report from the late effects study committee of childrens cancer study group
Authors: Robison Leslie L. , Nesbit Mark E. , Sather Harland N. , Meadows Anna T. , Ortega Jorge A. , Hammond G. Denman
Published: February 2007

One hundred eighty‐seven patients diagnosed with acute lymphoblastic leukemia (ALL) between 1972 and 1975 were evaluated for height 6.4–8.8 years (median 7.2 years) from the time of diagnosis of their disease. All patients had been treated on protocols CCG‐101/143 conducted by the Childrens Cancer Study Group. After induction of remission, patients received either cranial radiation plus six doses of intrathecal methotrexate, craniospinal radiation, or craniospinal radiation plus abdominal radiation, followed by systemic maintenance chemotherapy for either 3 or 5 years. No significant difference was observed in the distribution of height percentiles at the time of diagnosis compared to expected population standards. After treatment an excess (P < 0.001) was observed in the proportion of patients in the lower percentiles in conjunction with a decrease in the proportion of patients in the higher percentiles. After adjustment for height at diagnosis, the only factor found to have significant impact on attained height percentile was exposure to craniospinal plus abdominal radiation (P < 0.001) where there was a fivefold excess in the proportion of patients below the fifth percentile for height. Craniospinal radiation only was not associated with a greater reduction in attained height percentile when compared to cranial radiation only.
Granulocytic sarcoma of breast: Aleukemic bilateral metachronous presentation and literature review
Authors: Gartenhaus Willa S. , Mir Rabia , Pliskin Alexander , Grunwald Hans , Wise Leslie , Papantoniou Panagiotis A. , Kahn Leonard B.
Published: February 2007

This report describes an unusual case of bilateral metachronous granulocytic sarcoma of the breast. The patient initially did not have evidence of leukemia and her marrow cell culture in soft agar (CFU‐C array) showed normal in vitro growth pattern. The patient was treated with systemic chemotherapy at a time when there was no evidence for systemic disease but she nevertheless developed meningeal leukemia and bone marrow disease 11 and 18 months, respectively, following the initial chemotherapy.
Acute lymphoblastic leukaemia with t(4; 11) follows neuroblastoma: A late effect of treatment?
Authors: Secker‐Walker Lorna M. , Stewart Elizabeth L. , Todd Audrey
Published: February 2007

The case presented is of a 7‐year‐old girl who developed acute lymphoblastic leukaemia (ALL) with t(4; 11)(q21; q23) 5 years after the onset of neuroblastoma and 4 months after completing treatment for a first relapse. Consideration is given to the relative importance in this case of genetic factors and chemotherapeutic drugs in the etiology of ALL.
The NCl's cancer centers program: Past, present, and future
Authors: Steckel Richard J.
Published: February 2007

Since passage of the National Cancer Act in 1971, the NCI Centers Program has promoted the establishment and the development of cancer centers of many types throughout the nation. These now include 20 comprehensive cancer centers, as well as a number of clinical and basic science centers that are supported through NCI core grants. Scientific productivity at NCI‐supported centers has been high. While cancer center core grants usually represent only a small proportion of the total extramural research support for a given institution, they are essential in providing shared resources and in pulling together the various component research programs of a center into a unified program. The future directions of the NCI centers program as a whole, as well as the role of cancer research centers within their communities and regions, are discussed.
Medical students' concepts of childhood cancer and its management
Authors: Hays Daniel M. , Hoffman Kaaren I. , Williams Kenneth O. , Siegel Stuart E. , Miller Robert
Published: February 2007

Medical students' attitudes toward cancer and patients with cancer were studied prior to and following a required pediatric clerkship which included contact with children on an oncology service. Emphasis in the study was placed on the students' reactions to the child with cancer, and these were compared with the same students' attitudes in the context of the adult with cancer or general oncology.

Early diagnosis is regarded as of more significance, and an aggressive therapeutic response following diagnosis of more urgency when the patient is a child. These attitudes, recognizing the importance of early diagnosis and expressing strong approval of aggressive therapy for the pediatric patient, increased during the clerkship. The students strongly supported a program aimed at return of the child to his normal activities with the least delay; recognized the special significance of long‐range surveillance for secondary effects in the pediatric patient; and recommended the “center” as opposed to the community hospital as the site for care of the child with cancer. In other areas of cancer management, including (a) the importance of psychosocial support, (b) the problems of emotional involvement of the physician with the patient, and (c) care of the dying patient, attitudes toward patients in the two age groups was not significantly different.
Urinary bladder tumors following cyclophosphamide therapy: A report of two cases with a review of the literature
Authors: Samra Yechezkiel , Hertz Marjorie , Lindner Arieh
Published: February 2007

Sterile hemorrhagic cystitis following cyclophosphamide (Cph) therapy is a relatively frequent and well‐documented phenomenon. On the other hand, cancer of the urinary bladder associated with Cph therapy is rarely observed. We present two cases and summarize 32 patients reported in the literature.

Thirty patients had malignant disease elsewhere, 27 of them nonsolid tumors. The other four patients received treatment with Cph for nonmalignant disease (systemic lupus erythematosus—3; rheumatoid arthritis—1). The bladder tumor developed several months to years after treatment. In 20 patients hemorrhagic cystitis antedated the tumors.

We conclude that hemorrhagic cystitis in patients on Cph therapy should indicate at least temporary withdrawal of the drug. The decision to resume treatment should be taken with extreme caution considering the risk of the development of bladder cancer.
Cisplatin and cytarabine administered intrapleurally as treatment of malignant pleural effusions
Authors: Markman Maurie , Cleary Stephen , King Mark E. , Howell Stephen B.
Published: February 2007

Eight patients with histologically‐documented malignant pleural effusions received a total of ten courses of intrapleurally administered chemotherapy with cisplatin (100 mg/m2) and cytarabine (10−2M). Sodium thiosulfate was simultaneously administered intravenously to protect against cisplatin‐induced nephrotoxicity. There was no local toxocity observed and the only significant systemic toxicity (bone marrow depression) developed in a patient with poor marrow reserve prior to the initiation of therapy. Six of seven evaluable patients exhibited major reductions (> 75%) in the size of their effusions lasting for 2 to 10 plus months (median: 4 months). We conclude that the intrapleural administration of this chemotherapy regimen results in objective and subjective improvement in patients with malignant pleural effusions with minimal local and systemic toxicity (except for cisplatin‐induced emesis) and does not require chest tube drainage or prolonged hospitalization.
Acute and chronic hepatitis in childhood leukemia: A multicentric study from the italian pediatric cooperative group for therapy of acute leukemia (AIL‐AIEOP)
Authors: Locasciulli A. , Alberti A. , Rossetti F. , Santamaria M. , Santoro N. , Madon E. , Miniero R. , Curto M. Lo , Tamaro P. , Paolucci P. , Casale F. , Nespoli L. , Tucci F. , Masera G.
Published: February 2007

The incidence of acute and chronic liver damage and its relation to hepatitis B virus (HBV) infection was evaluated in 164 consecutive children with acute leukemia seen in ten Italian hemato‐pediatric units. Thirteen out of 164 children (7.9%) had acute hepatitis (AH) during treatment, while 8/90 (8.8%) showed an acute exacerbation of liver damage within 6 months after therapy withdrawal. Seven of the 13 children with AH while on therapy were HBsAg positive. In 12/13 cases, liver disease progressed to chronicity. Five of eight children who developed AH after completion of treatment were HBsAg positive. Eighty‐nine patients (54.2%) developed biochemical evidence of chronic hepatitis during therapy; 48/89 were followed after cessation of treatment and 33 of them showed persisting evidence of liver cell necrosis. Thirty‐three out of 133 children (24.8%) tested for serum HBsAg were found positive: 26 (78.7%) of them developed chronic hepatitis. Sixty‐four out of 133 patients were evaluated after cessation of treatment: Chronic hepatitis persisted in 16/22 HBsAg‐positive (72.7%) and in 17/42 HBsAg‐negative (40.4%) children during follow‐up. The outcome of these liver diseases after treatment withdrawal did not differ significantly in relation to HBV serology, suggesting that viral rather than toxic agents were responsible for liver damage also in most HBsAg‐negative patients. The high incidence of chronic HBV infection in children with leukemia found in this multicentric study could suggest a need for active immunization with HBV vaccine, but the efficacy of such approach in this clinical setting is still to be validated.
A morphometric classification of acute lymphoblastic leukemia in children
Authors: Seshadri Ram , Jarvis Lynn R. , Jamal Omar , Skinner John M.
Published: February 2007

In order to reduce the subjective errors in subtyping leukemic lymphoblasts using the French‐American‐British (FAB) classification, computer‐assisted morphometry was used. Bone marrow smears obtained at diagnosis from 99 children with acute lymphoblastic leukemia (ALL) were analysed by this method and compared with the subjective FAB classification. The results confirm that lymphoblast morphology, as a single variable, is a very significant predictor of survival in ALL. This computer‐assisted morphometric analysis would be of great value in large‐scale clinical trials in ALL.
Acute megakaryoblastic leukemia in down's syndrome: Report of a case and review of cytogenetic findings
Authors: Suarez Carlos R. , Beau Michelle M. Le , Silberman Simone , Fresco Raoul , Rowley Janet D.
Published: February 2007

A case of a child with trisomy 21 and acute megakaryoblastic leukemia (AMBL) is reported. Histological examination of the bone marrow showed progressive fibrosis and replacement with megakaryoblasts. The diagnosis was confirmed by platelet peroxidase reaction and immunofluorescent staining with anti‐factor VIII. Serial cytogenetic studies using banding techniques at various stages during the course of the disease (preleukemia, leukemia, remission, and relapse) showed several chromosomal abnormalities (unbalanced translocation between chromosomes 1 and 4 leading to trisomy 1q, trisomy 7q, monosomy 7p, and a reciprocal translocation between chromosomes 10 and 16). AMBL in childhood is probably more common than previously reported. Any association between AMBL and a particular cytogenetic abnormality must await further cytogenetic studies, specifically those employing banding techniques.
Phase I study of VP‐16 (etoposide) and amsacrine (AMSA) in the treatment of refractory acute leukemia
Authors: Letendre Louis , Hinemann Vicky , Hoagland H. Clark , Kovach John S.
Published: February 2007

Fourteen patients with refractory acute nonlymphocytic leukemia were entered into a dose‐seeking trial of combination therapy with etoposide and amsacrine given daily for five consecutive days. There were three complete responses lasting 2 months, 3 months, and 10 months and two transient partial remissions. Dose‐limiting toxicities were stomatitis and diarrhea. Prolonged aplasia occurred at the highest doses tested and appeared to result from repetitive doses of the combination given as maintenance. We recommend for induction and consolidation/intensification treatment VP‐16, 125 mg/m2, and AMSA, 125 mg/m2, intravenously daily for 5 days. A reduction by at least 50% in the dose of each drug is recommended for maintenance of complete remissions.
Response rate and survival in myeloma patients receiving prednisone alone
Authors: McIntyre O. Ross , Pajak Thomas F. , Kyle Robert A. , Cornwell Gibbons G. , Leone Louis
Published: February 2007

Thirty‐two evaluable good risk patients with multiple myeloma received a 70‐day tapering course of prednisone beginning at a dose of 1.2 mg/kg/day. Forty‐four percent of the patients demonstrated objective evidence of response to this treatment. Although the median time to disease progression for the prednisone‐treated group was shorter than for patients randomized to receive prednisone with alkylating agents or who were treated with alkylating agent alone, the results from this trial indicate that prednisone, by itself, may produce objective responses. Caution must be used interpreting trials of new agents in myeloma when such treatments are combined with corticosteroid administration.
Training and oncologists' changing attitudes toward their own cancer therapy
Authors: Schnaper Nathan , Orr Suezanne Tangerose , Wesley Margaret N. , Aisner Joseph
Published: February 2007

Oncologists' attitudes toward therapy for his or her own hypothetical cancer have not been studied, and they may influence therapeutic decisions for patients. This study compared attitudes of oncologists at different levels of training toward therapy for their own hypothetical cancer. Those with limited oncology experience had high expectations for treatment, as expressed in their acceptance of all therapeutic modalities for their own disease. Early intensive inpatient oncology experience (first year of training) led to disenchantment, and rejection of various therapies. Further outpatient experience led to an increased acceptance of therapy again, and those finishing second and third year of oncology training, and senior medical staff in oncology, had high expectations for treatment. These results suggest an evolution of attitudes toward therapy with training and experience.
Phagocytic activity and expression of myeloid‐associated cell surface antigens by blast cells in acute lymphoblastic leukemia
Authors: Pui Ching‐Hon , Mirro Joseph , Woodruff Linda , Motroni Tina , Stass Sanford
Published: February 2007

The malignant cells of patients with acute lymphoblastic leukemia (ALL) rarely show phagocytic activity. In this retrospective survey, blasts from 7 of 196 patients with newly diagnosed ALL demonstrated phagocytic activity toward platelets and erythrocytes. The morphology and cytochemical staining properties of the cells were typical of ALL. Immunophenotyes were those of common ALL (CALLA + HLA‐DR + ) for six patients and of pre‐B‐cell ALL (positive cytoplasmic immunoglobulin) for one. However, blast cells from six of the seven patients also reacted with myeloid‐associated monoclonal antibodies (MCS.2 and/or SJ‐D1). The wide overlap in the percentages of blasts expressing CALLA and those expressing myeloid‐associated antigens suggests that some cells possessed both lymphoid‐ and myeloid‐associated surface antigens. By a dual staining technique, two patients tested had blasts expressing antigens of both lineages. Each child achieved a complete remission alter treatment with agents effective for ALL and remains in remission for 13 + to 20 + months. These morphologic and immunologic findings may define a distinct subtype of acute leukemia.
Treatment of metastatic and recurrent cervix cancer with chemotherapy: A randomised trial comparing hydroxyurea with cisdiamminedichloro‐platinum plus methotrexate
Authors: Bezwoda W. R. , Nissenbaum M. , Derman D. P.
Published: February 2007

In a randomised trial comparing single‐agent chemotherapy (hydroxyurea) to combination chemotherapy in advanced cervix cancer, response was seen in 57% (including 13% CR) of patients receiving the combination (DDP + MTX) regimen. Responding patients survived significantly longer (11 months) than either those receiving hydroxyurea or those not responding to combination chemotherapy (4 months). Two patients remain in complete remission for 14+ and 17+ months.
Breast cancer after treatment for osteosarcoma
Authors: Knowling M. A. , Basco V. E.
Published: February 2007

Two cases of patients with primary osteosarcoma who developed subsequent new primary infiltrating ductal carcinoma of breast are presented. The relationship of irradiation from diagnostic radiology, chemotherapy given, and possible genetic factors are discussed. A recommendation for the lifetime follow‐up program of a patient with osteosarcoma should include careful attention to breast self‐examination and regular breast examination by the attending physician.
Simultaneous leptomeningeal and intramedullary spinal metastases in small cell lung carcinoma
Authors: Weissman David E. , Grossman Stuart A.
Published: February 2007

A patient with small cell lung carcinoma and simultaneous intramedullary spinal and leptomeningeal metastases is described. A review of the literature revealed that 28 cases of intramedullary spinal metastases have been reported in small cell lung carcinoma patients since 1978. Fifteen of these were in patients who had coexisting carcinomatous meningitis. The pathogenesis of intramedullary spinal metastases is discussed and a potential mechanism is proposed to explain the simultaneous occurrence of intramedullary and leptomeningeal metastases. Therapy for leptomeningeal metastases should be considered in patients with small cell lung carcinoma and intramedullary spinal metastases.
A case report and literature review of “primary” pulmonary histiocytosis X of childhood
Authors: Nondahl Susan R. , Finlay Jonathan L. , Farrell Philip M. , Warner Thomas F. , Hong Richard
Published: February 2007

“Primary” pulmonary histiocytosis X, a well‐described entity in young adult males in which pulmonary disease is the overriding site of involvement, is exceedingly rare in children younger than 15 years old. We report a new case in a 2‐year‐old male and review other reported prepubertal cases. The diagnosis of pulmonary histiocytosis X is based on examination of lung tissue. Langerhans cells containing Birbeck granules, seen by electron microscopy, are virtually pathognomonic of histiocytosis X. These Langerhans cells also react with a monoclonal antibody (OKT6) as well as with antibody to S‐100 protein. Based on the lack of consensus for the appropriate treatment of pulmonary histiocytosis X and on our patient's favorable response, we recommend initial therapy with corticosteroids alone, reserving more toxic agents for patients who fail to respond to this initial therapy.
Treatment of childhood acute lymphoblastic leukemia with intermediate‐dose cytosine arabinoside and adriamycin
Authors: Ishii Eiichi , Hara Toshiro , Ohkubo Kenshi , Matsuzaki Akinobu , Takeuchi Takami , Veda Kohji
Published: February 2007

Eight pediatric patients with acute lymphoblastic leukemia (ALL) were treated with intermediate‐dose cytosine arabinoside (ID‐AraC, 1 g/m2) in combination with adriamycin except one patient. Of the eight patients, four refractory to the initial induction therapy and one in bone marrow relapse gained complete remission with two to three cycles of this therapy. Four of the five patients have been in continuous remission for 4 to 24 months with the maintenance therapy of monthly administration of ID‐AraC. One patient in central nervous system (CNS) relapse has continued in remission from CNS leukemia after two cycles of the therapy. Side effects of ID‐AraC and adriamycin were generally mild to moderate and tolerable in all children. These results suggest that the use of ID‐AraC and adriamycin might prove effective in the treatment of ALL refractory to other regimens.
Bisantrene hydrochloride in gastric adenocarcinoma: A southwest oncology group study
Authors: Panettiere Frank J. , Jones Stephen E. , Oishi Noboru , Eyre Harmon J. , O'Bryan Robert M. , Andes W. Abe , Taylor Sarah A. , Grozea Petre N.
Published: February 2007

Because “the standard” chemotherapy for advanced gastric adenocarcinoma, the FAM combination of 5‐fluorouracil, adriamycin, and mitomycin, is only minimally effective, there is a clear need for other choices. Therefore, the Southwest Oncology Group tested the new adriamycin analog, bisantrene, hoping that it might be more effective than the “parent drug.” Twenty‐six patients with gastric adenocarcinoma were treated on a program of every‐3‐week 2‐hour bisantrene infusions. The starting dose was 260 mg/m2 (208 if poor risk), with subsequent doses based on prior toxicity. The regimen caused sufficient toxicity (especially local phlebitis with pain and swelling) to assure an adequate test. One person (3.8% of eligible patients) experienced a clinically useful 3‐month response. He had previously had progressive disease on FAM. Nevertheless, we conclude that bisantrene is not an addition to the small list of drugs useful in the management of gastric adenocarcinoma.
Prognostic relevance of clinical pharmacology of antileukemic drugs
Authors: Riccardi Riccardo , Lasorella Anna , Mastrangelo Renato
Published: February 2007

Response to treatment is the most important prognostic factor in children undergoing treatment for acute lymphoblastic leukemia. Factors that interfere with the pharmacokinetic determinants of anti‐leukemic compounds may cause a decreased activity of one or more of the drugs included in the treatment protocol. Noncompliance with the prescribed treatment, individual pharmacokinetic differences, interference with oral drug absorption, and different guidelines for dose reduction related to toxicity are some of the factors responsible for a decreased or variable antileukemic activity which may influence treatment results.
Pulmonary function abnormalities in long‐term survivors of childhood cancer
Authors: Miller Robert W. , Fusner June E. , Fink Robert J. , Murphy Thomas M. , Getson Pamela R. , Vojtova Jara A. , Reaman Gregory H.
Published: February 2007

Pulmonary function testing (PFT) was performed on 29 long‐term survivors of childhood cancer. The patients, whose mean age was 11.7 years and whose mean age at diagnosis was 3.7 years, included 12 females and 17 males. Original diagnoses included 15 patients with leukemia and 14 individuals with solid tumors. Nine patients had received cyclophosphamide and 20 had received radiation therapy. Included in this latter group were five patients who had received radiation therapy to the thorax. Eight patients had acquired pneumonia during their treatment.

Physical examination was normal in all the patients, and none had a history of acute or chronic pulmonary disease. PFT demonstrated an incidence of abnormalities in forced vital capacity (FVC) and/or total lung capacity (TLC) in 48% of the patients. Patients who were under 3 years of age at the time of diagnosis or who had received radiation to the thorax were more likely to demonstrate PFT abnormalities, but these differences did not reach statistical significance.

The natural history of pulmonary function and subsequent respiratory disease in survivors of childhood cancer requires further definition.
Induction failures in childhood acute nonlymphocytic leukemia: Etoposide/5‐azacytidine for cases refractory to daunorubicin/cytarabine
Authors: Kalwinsky David K. , Dahl Gary V. , Mirro Joseph , Jackson Carl W. , Look A. Thomas
Published: February 2007

Treatment with a combination of daunorubicin (45 mg/m2 IV, days 1–3) and cytarabine (100 mg/m2 continuous IV infusion, days 4–10) failed to induce complete remission in 31 of 87 children (36%) with acute nonlymphocytic leukemia (ANLL). Six patients with monocytic or promyelocytic leukemia died before day 14 of therapy from complications of hyperleu‐kocytosis and coagulopathy; an additional 10 failed because of fatal infections associated with drug‐induced marrow hypoplasia, and the remaining 15 had residual leukemia despite receiving two courses of daunorubicin and cytarabine. Alternative therapy with eto‐poside (250 mg/m2 IV, days 1–3, 7–9) and 5‐azacytidine (300 mg/m2 IV, days 4, 5, 9, 10) induced complete remission in nine (60%) of the 15 patients with resistant leukemia. Among the six children who failed to respond to either regimen, three had cytochemical and immunophenotypic features indicative of acute mixed‐lineage leukemia, and one had monosomy 7 syndrome. Our findings suggest that the addition of etoposide and 5‐azacyti‐dine to a basic daunorubicin‐cytarabine regimen would increase remission induction rates in childhood ANLL. Careful determination of pretreatment characteristics, including blast cell immunophenotype and cytogenetic properties, are needed to identify unusual cases of ANLL that may require selective therapy.
Cytogenetic studies of long‐term survivors of childhood acute lymphoblastic leukemia: A follow‐up report
Authors: Rubin Charles M. , Robison Leslie L. , Nesbit Jr. Mark E. , , Arthur Diane C.
Published: February 2007

Previous series including our earlier study of survivors of childhood acute lymphoblastic leukemia have documented the presence of nonclonal chromosome abnormalities in peripheral blood lymphocytes. To investigate whether or not these abnormalities persist, we restudied nine patients, all of whom had received radiotherapy and a minimum of 3 years of systemic chemotherapy. Therapy had been discontinued a median of 3.9 years prior to study in our first report and a median of 7.2 years prior to study in this follow‐up report. Thirty metaphases from short‐term cultures of phytohemagglutinin‐stimulated peripheral blood from each of nine patients and nine matched controls were analyzed using G‐banding. Nonclonal chromosome abnormalities were present in cells from six of the nine patients and 3.0% of patients' cells overall, as compared to seven of ten patients and 3.5% of patients' cells in the earlier study. All patients studied twice had abnormalities on one or both occasions. No evidence for the development of cytogenetically abnormal clones was found. Combined data from the two evaluations indicate that 1) all of the patients have a small population of long‐lived lymphocytes with nonclonal chromosome abnormalities, 2) the frequency of these cells appears to remain remarkably constant over time, and 3) the proportion of cells with chromosome abnormalities is approximately threefold greater in patients than in controls. It has become apparent that survivors of acute lymphoblastic leukemia are at increased risk for development of second malignant neoplasms. The relationship between therapy‐induced chromosome damage and the development of second malignant neoplasms is currently unknown. We speculate that some cells, possibly in tissues other than peripheral blood, are preneoplastic by virtue of therapy‐induced chromosome rearrangements involving critical genes and, following a long latent period, may undergo subsequent genetic or cellular changes that result in malignant transformation. Unfortunately, however, estimation of genetic damage through cytogenetic studies of peripheral blood T‐lymphocytes does not appear to be a useful method for prediction of second malignant neoplasms following acute lymphoblastic leukemia, since most or all of the patients have a low level of abnormal cells.
Ara‐C syndrome during low‐dose continuous infusion therapy
Authors: Powell Bayard L. , Zekan Patricia J. , Muss Hyman B. , Richards Frederick , Lyerly E. Susan , Capizzi Robert L.
Published: February 2007

Four patients with acute nonlymphocytic leukemia developed one or more components of the “ara‐C syndrome” including fever, peritonitis, pericarditis, and a maculopapular rash during therapy with continuous infusions of low‐dose (20 mg/m2/d) cytosine arabinoside (ara‐C). These complications, described with standard and high doses of ara‐C, have not been previously noted with lowdose regimens.
Bone marrow transplantation for acute monocytic leukemia following the treatment of hodgkin's disease
Authors: Russell James A. , Houwen Berend , Ruether Bernard A. , Shin Kyu H. , Jones Allan R. , Bowen Tom , Poon Man‐Chiu
Published: February 2007

A 32‐year‐old woman developed acute monocytic leukemia within a year of treatment for Hodgkin's disease with chemotherapy and radiation. Residual leukemia was present in the bone marrow after two induction courses of high‐dose Ara‐C. She received a bone marrow transplant from an HLA‐ and DR‐identical sister and remains in complete remission more than 2 years after transplantation. Only one other instance of a remission greater than 2 years after transplantation for secondary acute leukemia could be found in the literature. Although bone marrow transplantation may be carried out successfully in these patients, it is possible that they may be more vulnerable to transplant‐related complications because of their previous exposure to chemotherapy and radiation. Only further study can clarify this matter and determine the best time for the procedure and which regimen should be used.
Resistant and relapsing neuroblastoma: Improved response rate with a new multiagent regimen (OC‐HDP) including high‐dose cisplatinum
Authors: Dini Giorgio , Lanino Edoardo , Rogers David , Garaventa Alberto , Perin Giarmpiero , Stura Mauro , Dallorso Sandro , Cornaglia‐Ferraris Paolo , De Bernardi Bruno
Published: February 2007

From September 1984 to July 1985, 11 children from 6 months to 6 years of age were treated with a three‐drug regimen (OC‐HDP), including vincristine, cyclophosphamide, and cisplatinum 200 mg/m2 given as five dose‐fractions over 5 days. Nine had resistant and two relapsed neuroblastoma. Nine children had previously been treated with cisplatinum at conventional doses; nine had not received cyclophosphamide and ten had not received vincristine.

Nine of eleven patients had a good response to treatment; six are presently alive in continuous complete remission 11‐23 months (median 13 months) after diagnosis.

Toxicity was moderate: no child showed either severe myelotoxicity or clinical or laboratory evidence of nephrotoxicity. No child had clinically significant ototoxicity. In six children audiometry showed hearing loss for high frequencies after the third cycle of treatment. It is concluded that OC‐HDP regimen could be considered as a first‐line treatment for advanced neuroblastoma.
Massive acute hemolysis secondary to clostridium perfringens sepsis in a recently transfused oncology patient with multiple alloantibodies
Authors: Felix Carolyn A. , Davey Richard J.
Published: February 2007

Sepsis with clostridia species is seen infrequently in oncology patients, and the massive acute intravascular hemolysis known to be associated with these organisms is rare. The urgency of making the diagnosis of clostridial sepsis is imperative since the course is rapidly fatal if untreated. We describe a patient with metastatic adenocarcinoma of the pancreas, known to have recent transfusions as well as multiple red cell alloantibodies, who developed massive nonimmunologic hemolysis associated with Clostridium perfringens sepsis. Because the hemolysis of C. perfringens sepsis can mimic that of a severe delayed hemolytic transfusion reaction, care must be taken to differentiate these conditions, especially in view of the frequency of transfusion in these patients as well as their predisposition to develop disseminated infections.
Intensive chemotherapy including cisplatin with or without etoposide for children with soft‐tissue sarcomas
Authors: Crist William M. , Raney R. Beverly , Ragab Abdel , Heyn Ruth , Wharam Moody , Webber Bruce , Johnston Jean , Beltangady Mohan
Published: February 2007

Forty‐two children, 6 months to 17 years of age with newly diagnosed soft‐tissue sarcomas (gross residual or metastatic), were treated according to either of two pilot protocols that included intensive chemotherapy before irradiation. Vincristine, actinomycin D, cyclophosphamide, and doxorubicin were used in various combinations with cisplatin alone (regimen 35) or with cisplatin plus etoposide (regimen 36) in a 20‐week induction treatment; irradiation (4,000 cGy) was delayed until week 6. Fourteen (82%) of the 17 patients on regimen 35 and 15 (60%) of the 25 on regimen 36 had a complete response. Although severe leukopenia was frequent in both groups (88% and 84% of patients), there were only two fatal infections and no early deaths. Other potentially serious toxicity included a >10% weight loss in 52% of the patients and hypomagnesemia in 74%. An average of 75‐100% of the prescribed drug doses were administered during the induction phase of therapy. We conclude that this intensified treatment is toxic but feasible to deliver. The higher overall response rate compared to that in the preceding Intergroup Rhabdomyosarcoma Study (69% vs 53%) suggests improved therapeutic efficacy that warrants further evaluation of both regimens.
A randomized study comparing high‐dose methotrexate with moderate‐dose methotrexate as components of adjuvant chemotherapy in childhood nonmetastatic osteosarcoma: A report from the childrens cancer study group
Authors: Krailo M. , Ertel I. , Makley J. , Fryer C. J. H. , Baum E. , Weetman R. , Yunis E. , Barnes L. , Bleyer W. A. , Hammond G. Denman
Published: February 2007

Methotrexate (MTX) has demonstrated significant activity against relapsed and metastatic osteosarcoma. However, there is little published data to indicate the appropriate dose for MTX when given as a component of a multidrug regimen for the treatment of osteosarcoma. Therefore, the investigators at the Childrens Cancer Study Group undertook a randomized clinical trial that compared Adriamycin and vincristine given with either highdose methotrexate or moderate‐dose methotrexate as postoperation chemotherapy in the treatment of childhood osteosarcoma. We report here the results for 166 patients with completely resected nonmetastatic disease of an extremity.

The two therapies demonstrated equivalent disease‐free survival (DFS). Further, no therapy prejudices survival after relapse. Approximately 38% of patients remain disease free 4 years after diganosis. Two relapses occurred in patients free of disease at least 36 months after initiation of treatment. Some factors found by other investigators to be prognostic of poorer DFS, namely, male sex, primary tumor in the humerus or femur, and larger primary tumors, demonstrated similar though not statistically significant trends. The presence of spontaneous necrosis in the tumor sample from the definitive surgery was associated with poor prognosis for DFS. We postulate that this feature represents rapidly growing tumors with increased potential for metastases.
Solid tumors preceding or following sarcoidosis
Authors: Brincker Hans
Published: February 2007

Eight cases of sarcoidosis diagnosed after a preceding malignant solid tumor are presented. An analysis of these eight cases along with four previously reported cases was unable to answer the question whether in some cases the development of sarcoidosis may be triggered or modified by a preceding treatment of a malignant tumor. However, in the reverse situation—sarcoidosis preceding cancer—an analysis of 23 such cases from the literature suggests 1) that sarcoidosis preceding cancer appears to be of the chronic active variety and 2) that lung and breast cancer may occur more often than expected after sarcoidosis. Thus, it is conceivable that the immunologic abnormalities associated with sarcoidosis may somehow promote the development of certain malignant tumors.

True sarcoidosis may be confused with local sarcoid reactions in cancer patients. One such case is reported in which the finding of a regional sarcoid reaction to a solitary lung metastasis from a uterine adenocarcinoma led to insufficient treatment in the belief that the patient had systemic sarcoidosis.
Update on basic research and clinical experience with metaiodobenzylguanidine
Authors: Beierwaltes William H.
Published: February 2007

I 131‐metaiodobenzylguanidine (MIBG) is an aralkylguanidine with certain structural similarities to norepinephrine (NE). It is concentrated, stored, and released from chromaffin granules in a manner almost identical with that of NE. It will image the enlarged adrenal medullae of adrenal medullary hyperplasia when the CAT and NMR scans are normal. It is more sensitive in detecting extra‐adrenal pheochromocytomas than CAT and NMR imaging. Because 46% of our 176 patients with histopathologically proved “benign” pheochromocytomas (pheos) have developed demonstrable metastases, with or without elevated plasma and urinary catecholamines, we now image all patients with “benign” pheos yearly. As of January 22, 1986 we had treated 28 patients with malignant pheos 71 times with MIBG. As of July 24, 1986, we had given 34 neuroblastoma patients 55 tracer closes. In some cases MIBG demonstrates more neuroblastoma than all other imaging modalities and this is helpful in staging. We have had 30‐50% objective regressions in neuroblastoma tumor mass in 3 out of the first 12 patients treated. These three patients had slower‐growing tumors and a lower body burden than the nonresponders. We also record the sensitivity of MIBG imaging of neuroendocrine tumors other than pheos and neuroblastomas.
Treatment of neuroblastoma with 131I‐metaiodobenzylguanidine: Experience of the Münster/Kassel group
Authors: Fischer M. , Wehinger H. , Kraus C. , Ritter J. , Schröter W.
Published: February 2007

I‐131‐metaiodobenzylguanidine was used for treatment of neuroblastoma stage IV in three children after surgery and or chemotherapy had failed to be effective. In two of the children with multilocular lesions, after an impressive improvement of clinical symptoms tumor progression was observed. Because in about 25% of children with relapsing neuro‐blastoma complete remission may be achieved by combining surgery, chemotherapy, and I‐ 131‐MIBG treatment, this therapeutic modality should be included in the therapeutic strategy of stage III and IV neuroblastoma.
Treatment of neuroblastoma with metaiodobenzylguanidine: Results and side effects
Authors: Treuner Jörn , Klingebiel Thomas , Bruchelt Gernot , Feine Ullrich , Niethammer Dietrich
Published: February 2007

Between April 1984 and December 1985 we treated ten children suffering from neuroblastoma in a total of 25 metaiodobenzylguanidine (MIBG) courses. Five had had a relapse of neuroblastoma stage III or IV, three had never achieved a remission in spite of intensive chemotherapy, and two were treated with an unstable remission. The children were each administered from 1 to 5 courses with a dosage per course of between 1,295 and 9,065 MBq. The sum of the single doses during the whole course of therapy ranged between 3,145 and 21,904 MBq per child. Five of five children suffering from bone pain and fever became free of complaints during the first three treatment days. Six of eight children with manifest tumor at onset of therapy responded well to the treatment: response extended from transitory decrease in elevated catecholamine levels in serum and urine to complete disappearance of large abdominal tumor masses. We also observed a decrease in bone marrow involvement and a stabilization of osteolytic lesions. Seven of these eight children died in spite of a good response from 55 to 350 days after the first MIBG treatment course. The only side effect we witnessed was a reversible bone marrow depression. In three children we combined the MIBG therapy with bone marrow transplantation.
Liver mass in a four‐year old child: Current considerations for diagnosis and treatment
Authors: Applebaum Harry , Frost Daniel B. , Kagan A. Robert , Steckel Richard J.
Published: February 2007

A case is presented of an embryonal sarcoma of the liver in a young child. The differential diagnosis of liver masses in children is reviewed, as well as the implications of diagnostic imaging studies for diagnosis, prognosis, staging, and the choice of treatment. The use of diagnostic imaging for guiding interventional diagnostic procedures and certain palliative approaches is also discussed.
Testicular tumor concomitant with von Recklinghausen's disease
Authors: Groot‐Loonen J. J. , Voûte P. A. , De Kraker J.
Published: February 2007

Neurofibromatosis or Von Recklinghausen's disease is an autosomal dominant disorder, associated with an excess of malignant tumors. The most common neurofibromatosis‐associated malignancies are derived from neurogenic tissues, although several malignancies that did not originate from neurogenic tissue are also described. This paper provides the first documentation of a patient with neurofibromatosis and a mixed germ cell tumor of the testis.
Clinical and pathological evolution of alpha chain disease to immunoblastic lymphoma and response to COMP chemotherapy
Authors: Rogers P. , Hill I. , Sinclair‐Smith C. , Bowie M.
Published: February 2007

A small adolescent with alpha heavy chain disease presenting as malabsorption and evolving to immunoblastic lymphoma is reported. The pathological evolution is documented by serial endoscopy and small intestinal biopsy. Clinical and pathological remission was obtained by the use of COMP combination chemotherapy.
Increased antithrombin III concentration in children with acute lymphatic leukaemia receiving L‐asparaginase therapy
Authors: O'Meara Anne , Daly Martina , Hallinan F. H.
Published: February 2007

Previous reports have observed a fall in antithrombin III (AT III) concentration in patients receiving L‐asparaginase as part of acute lymphatic leukaemia (ALL) induction therapy. The aim of this study was to define any qualitative changes in AT III that might arise during the course of L‐asparaginase therapy and predispose to coagulopathy.

Serial AT III profiles were studied in 12 patients with ALL receiving a course of L‐asparaginase for 21 consecutive days as part of induction therapy. AT III isoforms were examined by isoelectric focusing in polyacrylamide gels (IEF/PA) and immunoblotting, and no changes were observed throughout the study period. Contrary to expectation, AT III antigen was significantly increased on treatment, while AT III activity remained unchanged. Fibrinogen levels, in contrast, fell considerably by 1 week of therapy and had not reverted to pre‐treatment values 1 week after completion of asparaginase. No coagulation or bleeding disorders were observed during or after the study period.
Mitoxantrone in relapsed or refractory acute nonlymphocytic leukemia
Authors: Vredenburgh James J. , McLntyre O. Ross , Cornwell Gibbons G. , Ball Edward D. , Cornell Cornelius J. , Mills Letha E. , O'Donnell Joseph F.
Published: February 2007

Seventeen patients with relapsed or refractory acute nonlymphocytic leukemia were treated with 14 mg/m2 of mitoxantrone given in a 30‐minute infusion daily for three days. If the day fourteen bone marrow showed residual leukemia, a second course was given at the same dose for two days. Eight patients (47%) entered complete remission. Three patients (17%) had a partial response, four (24%) did not respond, and two (12%) died with hypoplastic marrows during treatment. Seven of the 12 relapsed patients entered a complete remission, as did one of the five refractory patients. Toxicity was acceptable; prolonged myelosuppression, moderate hepatic toxicity, and stomatitis were the only problems. Several dose schedules of mitoxantrone have been studied by other investigators with varying results. The three‐day schedule in the present study is similar to the schedule used for common induction regimens employing anthracycline drugs. On the basis of its activity and acceptable toxicity in relapsed and refractory ANLL patients, we feel that this schedule could be safely combined with other agents in future studies.