摘要:

AbstractPrevious 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

ISSN:0098-1532    

DOI:10.1002/mpo.2950140602

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

年代:1986

数据来源: WILEY

摘要:

AbstractIsolated testicular relapse (T.R.) in acute lymphoblastic leukemia (ALL) has an overall incidence of 10% and affects mainly patients off therapy. Multivariate analysis of pretreatment characteristics has shown that lymphadenopathy and splenomegaly are independently associated with increased risk of T.R. during maintenance and off therapy, respectively. Sequential biopsy studies have demonstrated that testicular biopsies are unable to detect scanty infiltrates and have no practical utility. Prophylactic gonadal irradiation produced equivocal results and should not be used because of its sterilizing effect. Intensive multidrug regimens or prolonged maintenance were unable to substantially reduce T.R. rate. On the contrary, intermediate‐dose methotrexate (IDM) early in remission has almost abolished T.R. These findings strongly support the hypothesis that testicular interstitium is a very peculiar site where blasts are partially protected from the drug action; high drug concentrations are required for the optimal cytocidal effect. There are sufficient clues of a link between the excess of late marrow relapse in male sex and the capacity of testes of harboring blasts. Therefore IDM early in remission should be routinely adopted for prevention of testicular leukemia and its potential of late sprea

ISSN:0098-1532    

DOI:10.1002/mpo.2950140603

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

年代:1986

数据来源: WILEY

摘要:

AbstractVP‐16 was used to treat newly diagnosed elderly (⩾65 yr) patients with acute nonlymphocytic leukemia (ANLL) and patients with blast crisis of chronic granulocytic leukemia (BI‐CGL). Our pilot study indicated that VP‐16 160 mg/m2intravenously daily for 5 days was well tolerated and suggested a direct dose‐response correlation. Thirty additional ANLL patients and 11 CGL patients were studied. Among 26 evaluable ANLL patients, we observed ten responses (38%) (seven complete remission and three partial remission), but none of 11 patients with CGL in blast crisis had meaningful responses. In patients who responded to treatment, myelosuppression was always reversed by day 25. Stomatitis was the major nonhematologic toxicity and appeared more severe with advancing age. We conclude that VP‐16 is active against ANLL and is well tolerated at doses higher than have been previously described. It remains to be shown that the present schedule is superior to the intermittent high‐dose or continuous low‐dose infusion schedules, which have been rec

ISSN:0098-1532    

DOI:10.1002/mpo.2950140604

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

年代:1986

数据来源: WILEY

摘要:

AbstractFour 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 lowdo

ISSN:0098-1532    

DOI:10.1002/mpo.2950140605

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

年代:1986

数据来源: WILEY

摘要:

AbstractTwo patients are described in whomStreptococcus bovisbacteremia was the only clue to the presence of a colonic neoplasm. A third patient had the rare association of gastric carcinoma andStreptococcus bovisbacteremia that followed an operation for the carcinoma. The need for both complete gastrointestinal survey in patients withStreptococcus bovisbacteremia and administration of appropriate antibiotic prophylaxis during surgical manipulation is emphasized.

ISSN:0098-1532    

DOI:10.1002/mpo.2950140606

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

年代:1986

数据来源: WILEY

摘要:

AbstractSerologic testing of patients with acute lymphocytic leukemia for susceptibility to varicella was confounded by prior administration of blood products. Packed red cell transfusions produced fewer problems than plasmarich transfusions. Seronegative individuals may be transiently seropositive for several weeks. Specimens submitted for serologic testing should be accompanied by information on recent receipt of blood products.

ISSN:0098-1532    

DOI:10.1002/mpo.2950140607

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

年代:1986

数据来源: WILEY

摘要:

AbstractA 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 s

ISSN:0098-1532    

DOI:10.1002/mpo.2950140608

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

年代:1986

数据来源: WILEY

ISSN:0098-1532    

DOI:10.1002/mpo.2950140609

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

年代:1986

数据来源: WILEY

摘要:

AbstractThe occurrence of hepatocellular carcinoma in a 22‐year‐old man with thalassemia major is reported. As a result of transfusional hemochromatosis, this patient had already developed diabetes, hypogonadism, heart failure, and the sicca syndrome; he was serum and tissue HBsAg negative. Liver iron concentration measured postmortem was found to be 50 times normal.Multiply transfused patients are at risk of developing hepatocellular carcinoma. Serial measurements of serum alpha‐fetoprotein should permit early detection of the tumor and reduce mortality. Preventive measures include early immunisation against hepatitis B virus and prevention of iron accumulation by intensive use of desferrioxamine. Treatment of hemochromatosis‐associated hypogonadism with androgens should be considered with

ISSN:0098-1532    

DOI:10.1002/mpo.2950140610

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

年代:1986

数据来源: WILEY

摘要:

AbstractExtraneural relapse of medulloblastoma is an uncommon event which has typically been associated with a fatal outcome. We present a case of a 2 1/2‐year‐old male who developed extensive bone marrow and bone metastases 19 months after diagnosis and treatment of a medulloblastoma. This patient was successfully treated with a sequentially scheduled combination of vincristine, cyclophosphamide, and doxorubicin and remained free of disease for more than 5 years from the time of rela

ISSN:0098-1532    

DOI:10.1002/mpo.2950140611

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

年代:1986

数据来源: WILEY