摘要:

PurposeReports from the National Wilms' Tumor Study (NWTS) Group on the subject of chest computed tomography (CT) versus chest radiograph for the detection of lung metastases from Wilms tumor are reviewed.Patients and MethodsThirty-two patients with lung nodules detected by CT, with negative chest radiographs, were identified. Five patients were excluded from further analysis. Of the remaining 27 patients, 18 were treated as stage IV, receiving therapy with three drugs and lung irradiation; the other nine were treated with less intensive therapy and no lung irradiation. The investigators found no significant difference between the overall survival between these two groups of patients (94% and 88%, respectively). In an earlier study, four of 11 children (36%) with normal chest radiographs and positive chest CT results were treated by ignoring the CT findings. These data compared with a relapse rate of only 20% in a control population.ResultsThe studies do not statistically address the question of the impact of CT of the chest on survival.ConclusionsAll children should have the benefit of the most sensitive imaging available, including CT, to detect tumor spread.

ISSN:0192-8562    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PurposeThe impact of megakaryocyte growth in vitro on clinical data, especially outcome, was studied in 25 consecutive children with idiopathic thrombocytopenic purpura (ITP).Patients and MethodsTwenty children with untreated de novo ITP and five children with pretreated ITP were evaluated. The number of megakaryocyte colonies (cloning efficiency), the mean cell number per colony (mitotic amplification) and the percentages of polyploid megakaryocytes after 7 and 12 days in culture (relative size of the endomitotic compartment) were determined in two separate clonal assays. The culture data were related to clinical findings and outcome of the thrombocytopenia.ResultsThe mean cell number per megakaryocyte colony was significantly correlated with the observed increase in the platelet count 5 days after starting therapy (n = 23; r = 0.642), and a significant negative correlation was found between the relative size of the endomitotic compartment and the duration of thrombocytopenia after bone marrow culture analysis (n = 25; r = −0.503). If all 25 children with ITP (untreated de novo and pretreated ITP) were considered, a normal frequency of polyploid megakaryocytes was associated with a duration of ITP for <6 months in 14 of 16 cases, whereas an impaired polyploidization predicted a persistence of ITP for >6 months in 9 of 9 cases (p < 0.0005); if only children with untreated de novo ITP (n = 20) were considered, 13 of 15 children with a normal polyploidization had an acute course of their ITP and 5 of 5 children with an impaired polyploidization developed chronic ITP (p < 0.003).ConclusionsThe results in this small group of patients suggest that the assessment of the relative size of the endomitotic compartment after 7 and 12 days in plasma clot culture actually appears to be the best method for predicting a chronic course in children with ITP.

ISSN:0192-8562    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PurposeWe review the experience with autologous peripheral blood cell transplantation (APBCT) in children with neuroblastoma at the University of Minnesota.Patients and MethodsAspects of peripheral blood cell collection and use in nine patients who had advanced neuroblastoma (eight Evans stage IV, 1 stage III), who were median age 4 years (range 10 months-22 years), and who were treated with high-dose chemotherapy without total body irradiation and APBCT between September 1987 and December 1989 are reviewed.ResultsA median of 4.8 × 108(range 3.3–8.9) mononuclear cells per kilogram of body weight were obtained by a median of six (range four-eight) collections. In vitro assay of granulocyte-monocyte colony-forming cells (CFU-GM) demonstrated a median of 3.6 × 104(range 0.7–7.8) CFU-GM/kg of body weight. After APBCT, granulocyte recovery (absolute neutrophil count >500 × 106/L) occurred at a median of 28 days (range 14–72) and platelet recovery (>150 × 109/L) occurred at a median of 34 days (range 19–202). All patients but one, who had progressive disease, were transplanted with residual disease. Immunocytological analysis of peripheral blood stem cell harvest showed the presence of circulating neuroblastoma cells in three of nine patients, all of whom had minimal marrow residual disease by biopsy. One patient is still alive with no evidence of disease after 5 years. The others died of recurrent neuroblastoma a median of 14 months (range 3–29) after transplant.ConclusionAPBCT is safe and effective for hematopoietic reconstitution after high-dose chemotherapy, and may be useful when a bone marrow harvest cannot be performed because of prior pelvic radiation or minimal residual bone marrow metastasis. Immunocytological methods to ensure that the product is free of tumor contamination should be performed.

ISSN:0192-8562    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PurposeTo determine the relationship between hematological toxicity and actual dose intensity of treatment of patients randomized to therapy during the first 28 months of the National Wilms' Tumor Study-4.Methods: The mean minimum white blood cell count (WBC), platelet count (PLT), hemoglobin, and absolute neutrophil count (ANC) during the first two courses of chemotherapy and the mean number of days of hospitalization for toxicity were compared between standard and “pulse-intensive” regimens for all randomized patients entered on National Wilms' Tumor Study-4 between August 6, 1986 and December 31, 1988. The mean dose intensity of dactinomycin, vincristine, and doxorubicin received during the first two courses and the entire course of treatment was compared between standard and “pulseintensive” regimens.ResultsThe mean minimum WBC, PLT, and ANC were all significantly lower during the first two courses of chemotherapy for stage I patients treated with the standard regimen, compared with the “pulse-intensive” regimen. The mean dose intensity of dactinomycin and doxorubicin was significantly higher for patients treated with the “pulse-intensive” regimens, compared with the appropriate standard regimen.ConclusionsThe “pulse-intensive” administration schedule for the treatment of children with Wilms' tumor permits administration of chemotherapy at a higher dose intensity without an increase in hematological toxicity.

ISSN:0192-8562    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PurposeTo evaluate the kinetics of erythropoietin (EPO) production and address the pathogenesis of anemia of prematurity, we measured EPO levels in infants during the first year of life.Patients and MethodsUsing a radioimmunoassay, serum EPO levels were measured in 97 infants classified into three groups according to weight: group A, n = 40, <l,500 g; group B, n = 19, 1,500–2,499 g; and group C, n = 38, ≥2,500 g.ResultsThe serum EPO level ranged widely during the early neonatal period from days 0 to 6 (group A, <5 to 307 mU/ml; group B, 10–340 mU/ml; and group C, 9–108 mU/ml). EPO reached its lowest level (<20 mU/ml) between days 7 and 50 in all groups. The hemoglobin concentration reached its nadir between days 51 and 150 in all groups, with the lowest concentration observed in low birth weight infants. In contrast, the EPO level during the anemic phase was ~20 mU/ml and was independent of birth weight. A negative correlation between serum EPO level and hemoglobin concentration was observed only in group C (r = −0.54, p < 0.05). The negative slope of the regression equation in group C exceeded that of groups A and B (p < 0.05). When the relationship between EPO and Hb was evaluated over periods of 7–50 days, 51–100 days, and >101 days, respectively, we noted a significant correlation between values on days 7 and 50 in group A (r = −0.53, p < 0.05) and between days 51 and 100 in group B (r = −0.76, p < 0.05).ConclusionsThese data suggest the appreciable EPO production in premature infants, but its insufficient response to the depressed hemoglobin level, implying the need to administer exogenous EPO to infants with anemia of prematurity.

ISSN:0192-8562    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PurposeThe purpose of this study was to characterize pain reporting among children with sickle cell anemia (SCA) experiencing painful vaso-occlusive crises. These patients were managed according to a protocol based on self-reports of pain.Patients and MethodsSeventeen children (3–18 years) with SCA (Hb SS) who were admitted for painful crisis were asked to report their pain according to a rating scale of 0–5. These pain scores were analyzed according to the Mann-Whitney method to determine differences in pain reporting among young children (3–12 years) and adolescents (13–18 years). The Kruskal-Wallis method was utilized to determine relationships between the number of painful body sites, reported pain scores, and length of hospital stay.ResultsChildren (3–12 years) reported significantly less severe pain than adolescents (13–18 years) (p < 0.01). The severity of pain reported was not related to the number of painful sites. However, the length of stay was significantly longer in patients with greater numbers of painful sites (p < 0.05). Patients who reported pain scores of >2 at 24 h had significantly longer periods of hospitalization.Conclusion: A protocol based upon self-reports of pain was successfully utilized to provide analgesia during painful crises. There were characteristic differences between young children and adolescents in self-reporting of pain. Pain scores may be helpful in predicting length of hospitalization for painful crises.

ISSN:0192-8562    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PurposeWe tested the hypothesis that weight for height, a simple index of nutritional status, is related to prognosis in childhood acute lymphoblastic leukemia (ALL).Patients and MethodsThe study population was composed of 78 children with ALL tested at one U.K. center on the same protocol (UKALL-X). Outcome measures were relapse/no relapse and time to first relapse. Influence of weight for height, expressed as standard deviation scores, was tested using survival analysis in a retrospective design.ResultsThe weight-for-height standard deviation score had a significant influence on time until first relapse (log ranks test, p = 0.012), with the highest risk of early relapse in children at the lower end of the weight-for-height distribution.ConclusionsThe results suggest that weight for height does have an influence on outcome in ALL, but the mechanism is unclear and the finding requires confirmation by larger scale prospective studies.

ISSN:0192-8562    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PurposeThis study was undertaken to evaluate the safety and efficacy of granisetron (a 5-hydroxytryptamine3antagonist) in children with malignant disease who had previously experienced unacceptable nausea and vomiting and/or adverse effects associated with standard antiemetic therapy.Patients and MethodsThirty children 3–18 years of age who were receiving anticancer chemotherapy were enrolled in the study. Patients received a prophylactic dose of granisetron before chemotherapy and two subsequent doses as needed. If further antiemetics were required, standard therapy was given and those patients were classified as treatment failures. Patients received granisetron during one to three cycles of chemotherapy; a total of 66 courses were given.ResultsEighty-seven percent of patients had good control of nausea and vomiting with granisetron alone; 90% of patients elected to receive granisetron with subsequent chemotherapy. No loss of efficacy was noted with repeated cycles in 21 patients. No serious adverse events occurred.ConclusionsIntravenous granisetron (20 μg/kg/dose) appears to be a safe and effective drug for pediatric patients receiving emetogenic chemotherapy.

ISSN:0192-8562    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PurposeIn a prospective crossover study, we evaluated the safety and antiemetic activity of granisetron, a 5-hydroxytryptamine3(5-HT3) receptor antagonist, compared with conventional antiemetics regimen, including metoclopramide, in pediatric cancer patients.Patients and MethodsTwenty-two children with malignant diseases were enrolled. The chemotherapy included cytarabine 3 g/m2(regimen A), cisplatin 90 mg/m2(regimen B), and actinomycin D 900 μg/m2plus ifosfamide 3 g/m2(regimen C). Granisetron 40 μg/kg was infused over 30 min just before each chemotherapy treatment.ResultsA complete response was obtained more often with granisetron than with conventional antiemetics (59.1% vs. 0%, p < 0.001). In terms of efficacy by chemotherapy type, complete response with granisetron was obtained in eight of 10 patients with regimen A, three of eight with regimen B, and two of four with regimen C. Major efficacy (vomiting fewer than two times) was also obtained more with granisetron than with conventional antiemetics (81.8% vs. 4.6%, p < 0.001). The number of vomiting episodes in the first 24 h was less with granisetron than with conventional antiemetics (1.1 × 1.46 vs. 9.0 × 4.97, p < 0.001). Normal appetite and activity were retained in more patients with granisetron than with conventional antiemetics. Extrapyramidal reactions, akathisia, and sedation were not seen in any case with granisetron.ConclusionsGranisetron 40 μg/kg is well tolerated and more effective than are conventional antiemetic regimens containing metoclopramide for children receiving cancer chemotherapy.

ISSN:0192-8562    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

PurposeWe evaluated the antiemetic efficacy of tropisetron, a 5-HT3 receptor antagonist, during its compassionate use in children with malignant disease who during previous chemotherapy cycles experienced emesis refractory to metoclopramide-based treatments.Patients and MethodsTropisetron was given to 15 children (eight boys and seven girls 18 months to 18 years of age) with miscellaneous neoplasms. Generally 5 mg/day of tropisetron was administered i.v. the first day of cisplatin-based chemotherapy and i.v. or orally each subsequent day of chemotherapy. The dose of tropisetron was reduced to 2 mg/day in children <2 years of age and weighing <20 kg.ResultsVomiting was well controlled (no more than two episodes per day) on 118 of the 184 days of treatment with tropisetron (64%). No clinically important variations were observed in blood pressure, heart rate, body temperature, or electrocardiographic findings attributable to tropisetron. Transient, mild to moderate side effects (headache, constipation, abdominal pain, diarrhea) occurred in five patients on 11 of the 184 days of tropisetron treatment (6%).Conclusion: The results obtained during compassionate use of tropisetron confirm that it is a valid, safe, and manageable antiemetic for the treatment of pediatric patients.

ISSN:0192-8562    

出版商:OVID    

年代:1994

数据来源: OVID