摘要:

AbstractThe health‐related beliefs and behaviors of long‐term survivors of childhood cancer are important because of vulnerability to adverse late effects from their primary malignancy and its therapy. A health behavior survey was completed by 110 parents of long‐term survivors ranging in age from 11–17 years, and by 40 adult long‐term survivors of childhood cancer ranging in age from 18–29 years. The survey included questions on the former patient's frequency of alcohol and tobacco use, as well as diet, exercise, sleep, dental, and seatbelt habits. The reported prevalence of tobacco and alcohol use was less than 10% among those less than 18 years old. Among the adults, tobacco (17.5%) and alcohol (72.5%) use was greater, but problem drinking was infrequently reported. In order to assess their perceived vulnerability, we asked the parents and the young adult patients to rate the strength of their belief that it is more important for the patient to keep healthy compared to most other children or young adults. Contrary to our expectations, demographic factors such as the patient's gender, socioeconomic level, or time elapsed since completion of therapy exerted minimal influence on their responses. Over 80% of parents and 60% of young adult survivos believed that it was more important for the former patient to remain healthy compared to most other people. However, this shared belief in increased vulnerability was inconsistently expressed in the patient's health behaviors. These results suggest that specific changes are needed in the health assessment and education of long‐term survivors of childhood cancer. © 1995 W

ISSN:0098-1532    

DOI:10.1002/mpo.2950250302

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

年代:1995

数据来源: WILEY

摘要:

AbstractIn a multicentre randomised clinical trial 364 children with biopsy proven medulloblastoma were randomly assigned to receive or not pre‐radiotherapy chemotherapy. Children with total or subtotal removal of the tumour, no evidence of invasive brain stem involvement, and no evidence of metastatic disease either within or without the cranium were designated “low risk”, those with gross residual tumour, evidence of invasive brain stem involvement or metastases in the central nervous system were designated “high risk”. All children were prescribed 55 Gy to the tumour bearing area. “Low risk” children could be randomised to “standard” radiotherapy 35 Gy to the craniospinal axis or “reduced” dose 25 Gy to the craniospinal axis. Chemotherapy consisted of vincristine, procarbazine, and methotrexate given in a 6‐week module before radiotherapy, and for “high risk” children, vincristine and CCNU given after radiotherapy. No benefit for the receipt of pre‐radiotherapy chemotherapy could be demonstrated for any group. In addition, a negative interaction was observed between the receipt of the chemotherapy and reduced dose radiotherapy with a particularly poor outcome being observed in this group of chi

ISSN:0098-1532    

DOI:10.1002/mpo.2950250303

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

年代:1995

数据来源: WILEY

摘要:

AbstractTwenty children with acute leukemia between 3 and 19 years of age underwent allogeneic bone marrow transplantation from HLA‐matched sibling donors after conditioning with total‐body irradiation (1,200 cGy in six fractions of 200 cGy twice daily for 3 days) and high dose cytosine arabinoside (3 g/m2given every 12 hours for 12 doses). Three patients died with acute toxicity. Six patients developed grade II acute graft versus host disease. With a median follow‐up of 68 months (range 26–96 months), thirteen children (65%) are alive and in remission with Karnofsky scores of 90–100%. A patient with AML in resistant relapse went into remission but relapsed and died 5 months post‐transplantation. Three other patients relapsed, 8, 12, and 16 months post BMT. Our results suggest that this conditioning regimen is associated with high but manageable acute toxicity and may be highly effective in controlling leukemia resistant to conventional chemotherapy. © 1995 Wil

ISSN:0098-1532    

DOI:10.1002/mpo.2950250304

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

年代:1995

数据来源: WILEY

摘要:

AbstractAnthracyclines (doxorubicin, daunorubicin, and derivatives) are among the most effective antineoplastic drugs for pediatric cancer with dose‐limiting acute and longterm cardiotoxicity. The exact mechanism of the development of cardiomyopathy is still not clear. Anthracyclines may induce subclinical acute myocardial injury leading to lysis of a limited number of myocytes. Alternatively, myocytes may experience a transient loss of cytoplasmic membrane integrity. Both conditions may lead to a transient efflux of small amounts of cytoplasmic enzymes and other proteins specific to the heart muscle fibers.To test these hypotheses we assayed plasma creatine kinase (CK) MB mass and cardiac specific troponin T (TnT). CKMB may be released even in case of reversible cell membrane injury, while prolonged elevation of TnT is the most sensitive and specific marker of limited myocardial necrosis.Thirty‐five anthracycline‐containing chemotherapy courses in 22 children with cancer were analyzed. CKMB mass and TnT concentrations were within the normal range in all children before anthracycline therapy. Within 72 hours from anthracycline therapy no increment of one of these two marker proteins was detected (ANOVA for repeated measures,P= 0.94 [TnT] and 0.25 [CKMB]).We conclude that only minimal if any acute necroses of cardiac myocytes occur after anthracycline therapy. Even membrane integrity appears to be maintained within the first 3 days after anthracycline therapy, in the absence of electrocardiographic or echocardiographic signs of acute cardiotoxicity. © 1995 Wiley‐L

ISSN:0098-1532    

DOI:10.1002/mpo.2950250305

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

年代:1995

数据来源: WILEY

摘要:

AbstractThirteen patients with recurrent medulloblastoma were treated with cyclophosphamide in association with Sargramostim. Cyclophosphamide was given at doses ranging between 1.0–2.5 g/m2daily for two doses. Sargramostim was given at a fixed dose of 250 μg/m2subcutaneously twice a day beginning 24 hours after the second cyclophosphamide dose and continuing through the leukocyte nadir until the ANC was more than 1,000 cells/μl for two consecutive days. A total of 33 courses were given with toxicity consisting of grade 4 neutropenia in all courses and grade 3–4 thrombocytopenia in 10 of 13 patients. There were no deaths related to infection or bleeding. Four patients were taken off study because of prolonged myelosuppression. Three of these patients were at the 2.5 g/m2level, and of these three, two developed lung toxicity (grades 2 and 4, respectively). One patient developed an allergic reaction following the first injection of Sargramostim and was also taken off study. Of 10 evaluable patients, there were 9 PR and 1 SD. We conclude that cyclophosphamide at a dose of 2.0 g/m2/day × 2 days q 4 weeks in association with Sargramostim demonstrates marked activity with acceptable toxicity in patients with recurrent medulloblastoma. © 1995 Wiley‐

ISSN:0098-1532    

DOI:10.1002/mpo.2950250306

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

年代:1995

数据来源: WILEY

摘要:

AbstractWithin a population of 882 million, six thousand children will develop acute lymphoblastic leukemia each year in India. These children come from three socio‐economic backgrounds: Profile I (70%) being extremely poor who cannot afford any treatment unless it is provided free, Profile II (25%) from the middle class, and Profile III (5%) who can afford to have the best possible treatment. Current protocols for childhood ALL range from simple low‐cost regimes like UKALL VIII, intermediate intensity regimes like BFM 76/79, and aggressive regimes aimed at increasing cure rates in the high risk groups. Since state resources are limited, the pediatric oncologist in India has to decide on the appropriate treatment protocol for the individual child in each of these profiles. This paper suggests an approach to managing childhood ALL in developing countries like India. © 1995 Wiley‐Lis

ISSN:0098-1532    

DOI:10.1002/mpo.2950250307

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

年代:1995

数据来源: WILEY

摘要:

AbstractChildhood leukemic hyperleukocytosis poses a serious threat to life because of its associated metabolic complications. The present prospective trial utilized conservative management of childhood acute lymphoblastic leukemia with hyperleukocytosis (total white cell count equal or>100 × 109/L) by intravenous hydration, urinary alkalinization, and allopurinol presenting without severe life‐threatening complications. The median reduction in WBC count was 81.51% (range: 66–98.8%) within a median period of 36 hours (range: 12–60 hours) following hospitalization. There were no failures or treatment related complications. Thus we conclude that in childhood acute lymphoblastic leukemia, hyperleukocytosis can be managed safely and effectively with intravenous hydration, urinary alkalinization, and allopurinol before starting any specific anti‐leukemic chemotherapy avoiding risk‐associated cranial irradiation, leukapheresis, and exchange transfusion. © 1995 Wile

ISSN:0098-1532    

DOI:10.1002/mpo.2950250308

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

年代:1995

数据来源: WILEY

摘要:

AbstractImmunological abnormalities have been described in patients with Hodgkin's disease, both associated with the malignancy itself and occurring secondary to therapy. These abnormalities often manifest as an immunodeficiency state, but can also present as immune dysregulation and autoimmune disease. We report two young patients with Hodgkin's disease who, following successful therapy, developed urticarial vasculitis (UV), a form of cutaneous autoimmune vasculitis. Both patients also had systemic symptoms including fever, an elevated erythrocyte sedimentation rate and serum copper, and abnormal in vitro studies of lymphocyte enumeration and proliferation. Distinguishing UV from recurrent Hodgkin's disease was especially difficult in one patient, and was possible only by lymph node biopsy. One patient has responded well to immunosuppressive therapy, while the other, who has more profound immune dysfunction, has developed a chronic autoimmune disorder. UV may thus occur in patients after therapy for Hodgkin's disease; we hypothesize that immune dysregulation, either associated with the malignancy or resulting from therapy, is important in the pathogenesis of this autoimmune process. © 1995 Wiley‐Liss, I

ISSN:0098-1532    

DOI:10.1002/mpo.2950250309

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.2950250310

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.2950250311

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

年代:1995

数据来源: WILEY