摘要:

AbstractCycling intensive chemotherapy currently used to treat pediatric solid tumors induces severe neutropenia. Prolonged neutropenia is a major risk factor for septic death which occurs in up to 5% of febrile or septic neutropenic episodes. We treated 18 neutropenic pediatric cancer patients (eight females, 10 males) during 30 febrile and/or septic episodes with single daily doses ofE. coli‐derived non‐glycosylated recombinant human granulocyte‐macrophage colony‐stimulating factor (rh‐GM‐CSF, 5 μg per kg of body weight). The cytokine was administered for a median period of 6.5 days (2–12 days). Analysis of circulating hematopoietic progenitor cells was performed at day 1 (baseline) and day 5 of rh‐GM‐CSF treatment and included flow cytometric CD34 analysis as well as the methylcellulose‐based clonogenic assay.Prompt hematopoietic recovery and resolution of septic problems was observed in all children. The counts of leukocytes (WBC), absolute neutrophils (ANC), and platelets (PLT) rose above 1,000/μL, 1,000/μL, and 50,000/μL within 4 days (0–9), 5.5 days (2–13), and 6 days (0–14), respectively. Faster granulocyte recovery and improved recruitment of circulating hemopoietic precursors was observed in children with detectable amounts (>0.1%) of CD34‐positive mononuclear cells prior to rh‐GM‐CSF treatment.We conclude that, to some extent, the efficacy of rh‐GM‐CSF treatment in neutropenic cancer patients is influenced by the hematopoietic recovery status on the progenitor cell level. Although they respond more slowly to the treatment, patients without circulating CD34‐positive progenitor cells may gain most from growth factor therapy. Rh‐GM‐CSF can be safely administered to febrile and/or septic neutropenic childr

ISSN:0098-1532    

DOI:10.1002/mpo.2950250502

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractThis study reports the outcome after relapse of acute lymphoblastic leukemia (ALL) in a population‐based study of 809 children over 1 year of age diagnosed July 1981 through June 1986 and with non‐B acute lymphoblastic leukemia in the five Nordic countries. By January 1994, 315 children had suffered at least one relapse. The bone marrow was involved in 216 cases. There were 69 isolated CNS relapses, 25 isolated testicular recurrences and five relapses in other extramedullary sites.Of the 315 children with relapse, 94 are still in a second complete remission 12–138 (median: 78) months after relapse. The overall probability of a second event free survival (P‐2.EFS) and survival after relapse was 0.28 and 0.33 respectively. The probability of remaining in second remission at 11 years was significantly correlated to the duration of first remission (P<0.001), the site of relapse (P<0.001) and gender (P= 0.004). TheP‐2.EFS for early, intermediate, and late bone marrow involved relapses were 0.08, 0.19, and 0.50 respectively. For early, intermediate and late isolated CNS relapses theP‐2.EFS were 0.21, 0.38 and 0.61, respectively.TheP‐2.EFS for boys with isolated testicular relapses was 0.69. Girls with isolated CNS relapse (P<0.001) and with bone marrow involved relapse (P= 0.04) had a significantly better prognosis than boys.Children with initial high risk criteria, especially T‐ALL and mediastinal mass who relapsed, had a very poor prognosis. Conclusion: In this population‐based study, about 30% of children with ALL obtained a long second remission and possible cure. © 19

ISSN:0098-1532    

DOI:10.1002/mpo.2950250503

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractNutritional problems often result from malignancies and aggressive multimodal treatment. Early identification of reliable risk factors associated with malnutrition and need for nutritional support is necessary for development of preventative approaches. Nutritional and treatment‐related characteristics were examined for 173 pediatric oncology patients referred for nutritional support and a comparison sample of 43 patients matched on treatment protocol and/or diagnosis who had never been referred for nutritional support. Abnormally low serum albumin levels, poor oral intake, mucositis, prior radiation therapy, and increased gastrointestinal toxicity were significantly more frequent among referred than non‐referred patients. A discriminant function analysis indicated that poor oral intake was the single best predictor of need for nutritional support. Patients with solid tumors were more nutritionally depleted at the time of referral; all bone marrow transplant patients received nutritional support. Patients with central nervous system (CNS) tumors required nutritional support for longer time periods. We conclude that routine documentation of poor oral intake (i.e., observation of change in a child's eating patterns) is the most reliable indicator of children who eventually require nutritional support and who may benefit from interventions that could delay or prevent nutritional problems. Prophylactic interventions should be tailored to meet the specific needs of individual diagnostic groups. © 1995 Wiley‐Lis

ISSN:0098-1532    

DOI:10.1002/mpo.2950250504

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractHistorically, there has been evidence to support the hypothesis that survivors of childhood cancer have been discriminated against in the private health insurance market in some areas of the United States. Results of previous studies have been inconsistent and have generally focused on a limited number of outcome variables. A retrospective cohort study of young adult survivors of childhood cancer and their siblings was performed to determine the risk of health insurance access problems of childhood cancer survivors in North Carolina. Mailed questionnaires were completed by 182 cancer survivors from three institutions who were diagnosed between 1976 and 1988, and by 101 of their siblings for a response of 62.1%. Using logistic regression in SAS, cancer survivors were found to be more likely to be denied health insurance than their siblings, with an adjusted odds ratio of 15.1. Childhood cancer survivors also had health insurance policies that excluded care for pre‐existing medical conditions more often than their siblings (OR = 5.5). In addition, cancer survivors reported problems obtaining health insurance coverage more frequently than their siblings with an adjusted odds ratio of 22.8. In general, survivors of childhood cancer who were diagnosed in North Carolina have had decreased access to health insurance coverage when compared to their siblings of similar age. North Carolina health insurance regulations permit health insurance firms to discriminate against cancer survivors because of their history of illness, often decreasing their access to needed follow‐up care. © 1995 Wiley‐Lis

ISSN:0098-1532    

DOI:10.1002/mpo.2950250505

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractA trial was undertaken to assess the efficacy and toxicity of high‐dose cisplatin and etoposide in children with newly diagnosed advanced malignant germ cell tumors. A total of eleven children and adolescents were treated with courses of high dose cisplatin 30 mg/m2/day and etoposide 120 mg/m2/day in five day cycles at 21 day intervals. There were eight girls and three boys, aged between 1 and 16 years (median: 120 months). Of nine unresectable tumors, six were in complete remission after three cycles and were completely resected. All patients are alive (median follow‐up 17 months). Preliminary results shows that high dose cisplatin and etoposide is effective in controlling advanced malignant germ cell tumor. © 1995 Wiley‐Lis

ISSN:0098-1532    

DOI:10.1002/mpo.2950250506

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractThis study was performed to confirm the existence of immunoproliferative small intestinal disease (IPSID) in Pakistan. Clinicopathological features of 12 patients with histologically confirmed disease were analysed. Patients were mostly young males with median age of 24.6 years. Two thirds belonged to poor socioeconomic class. Main presenting features were chronic diarrhoea and weight loss. Eleven patients had radiologic evidence of malabsorption syndrome. Endoscopic findings of mucosal thickening, edema, and flattened villi were present in the majority. Patients had both secretory and non‐secretory types of disease. Six patients presented with stage A disease. Four responded to antibiotics or steroids, although mucosal abnormalities persisted in three. Two stage A patients evolved into stage C disease, one was lost to follow‐up, the other is alive with disease. Three patients presented with stage B disease. Two responded completely to chemotherapy, the third refused treatment and expired after 16 months. Three patients had stage C disease at diagnosis. They received aggressive combination chemotherapy and remain in complete remission with a median follow‐up of 2.2 years. This is the first series of patients with IPSID reported from Pakistan. Clinicopathological features and therapeutic results are consistent with the experience elsewhere. Increased awareness may result in early diagnosis and better management. © 1995 Wiley‐L

ISSN:0098-1532    

DOI:10.1002/mpo.2950250507

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBetween 1968 and 1987, 356 previously untreated consecutive children with Hodgkin's disease (HD), aged under 14, were treated at the Pediatric Department of N.N. Petrov Research Institute of Oncology (St. Petersburg, Russia). Prevailing among histologic subtypes were lymphocytic predominance and mixed cellularity (34 and 31.7%, respectively). Two‐thirds of the patients (67.7%) were with Stages III‐IV and one‐third (32.3%) with Stages I‐II.Radiation therapy (RT) as a primary method of treatment was used in 72 patients (20.2%), chemotherapy (CT) in 76 (21.4%), and combined (RT + CT) therapy (CMT) in 208 cases (58.4%). The patients were followed from 6.3 to 26 years (median follow‐up was 13.7 years). For the whole group 5‐, 10‐, 15‐, 20‐, and 25‐year actuarial survival (S) rates were 90, 80, 74, 73, and 73%, respectively. The corresponding event‐free survival (EFS) rates were 63, 56, 56, 55, and 55%. The amelioration of the results was noted beginning with the 1973–1977 period, and for those treated in the last period (1983–1987) 5‐year S and EFS rates were 93 and 68%, respectively.We conclude, that the modern treatment is also effective for our children suffering from

ISSN:0098-1532    

DOI:10.1002/mpo.2950250508

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

ISSN:0098-1532    

DOI:10.1002/mpo.2950250509

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractAn 8‐year‐old boy presented with dysuria and acute retention of urine. Rectal examination showed a hard mass arising from the prostate. CT scan of the pelvis confirmed the presence of a large prostatic tumor causing bladder outflow obstruction. A provisional diagnosis of pelvic sarcoma was initially made. Biopsy of the tumor mass however, revealed non‐Hodgkin's lymphoma of T‐cell type. The tumor showed very good response to chemotherapy and the urinary obstruction significantly improved with a week after starting therapy. © 1995 Wiley

ISSN:0098-1532    

DOI:10.1002/mpo.2950250510

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractA 6‐year‐old boy presented with a unilateral renal tumour thought to be a Wilms' tumour. He had started a treatment but review of the histology and immunohistochemical studies proved the tumour to be a primary renal B‐cell lymphoma. This case illustrates the importance of an open‐minded approach in the histological examination of small round cell tumours in the kidney and immunohistochemical studies in such cases are strongly advocated. © 1995 Wiley

ISSN:0098-1532    

DOI:10.1002/mpo.2950250511

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY