John R. Hartmann

A Comparison of Marrow Transplantation with Chemotherapy for Children with Acute Lymphoblastic Leukemia in Second or Subsequent Remission

The progress of 24 children with acute lymphoblastic leukemia treated with cyclophosphamide, total-body irradiation, and marrow transplantation during a second or subsequent remission was compared with that of 21 children treated with conventional chemotherapy after they had entered a second remission. Eleven of the transplantation group are alive, including nine in continuing complete remission for 17 to 55 months; only two of the chemotherapy group are alive, one in complete remission after 20 months. Relapse was the major cause of failure in both groups. Acute and chronic graft-versus-host disease in the transplantation group and leukoencephalopathy in both groups were the other major causes of morbidity and mortality. This study demonstrates that marrow transplantation currently offers the best chance of long-term remission and potential cure after a child with acute lymphoblastic leukemia has had a relapse in the marrow.

Varying prednisone dosage in remission induction of previously untreated childhood leukemia.

Although prednisone has been effectively used to induce remission in acute leukemia, a controlled exploration of optimal dosage and of intermittent therapy has not been reported. Of 223 previously untreated children 86 received 2 mg/kg in three divided daily doses; 85 received 4 mg/kg in three divided daily doses; 28 received 8mg/kg every other day in a single dose and 24 received 16 mg/kg every fourth day in a single dose. Steroid side effects were minimal in intermittent therapy. The percentage of remissions on these two regimes, however, was significantly lower than on continuous therapy. Bone marrow remissions were found in 21% on 8 mg/kg every other day and 12% on 16 mg/kg every fourth day. Remission rates of 72% and 60%, respectively, were obtained on the 2mg/kg and 4 mg/kg regimens, indicating no significant difference between these two groups. Continuous prednisone therapy appears to be more effective than intermittent dosage regimens in inducing remission in acute childhood leukemia.

Seizures associated with vincristine sulfate therapy

Generalized seizures occurring five to six days following an intravenous injection of vincristine are described in four patients. No other cause for the seizures was documented. They occurred following doses within the normal therapeutic range (1.5 to 2 mg. per square meter once weekly) and in the absence of hyponatremia, which has previously been implicated in the pathogenesis of vincristine-induced seizures.

Long-Term Evaluation of Single versus Multiple Courses of Actinomycin D Therapy of Wilms's Tumor

Abstract Long-term analysis of the value of a single course (36 patients) versus multiple courses (37 patients) of actinomycin D in the treatment of Wilmss tumor showed that the relapse rate was significantly less in subjects given multiple-course chemotherapy. There was no significant difference in long-term survival between the two groups. Multiple courses appeared to suppress pulmonary metastases. Because of fewer relapses, fewer additional control measures were needed, and morbidity from the disease and its treatment was therefore lessened. Multiple-course therapy is preferred to a single course in Wilmss tumor. (N Engl J Med 290:84–86, 1974)

Helping the family cope with childhood cancer.

Recent advances in the treatment of childhood cancer have not only increased the possibility of cure and a normal life span for the patient, but have also introduced new stresses for the families of these patients. The authors describe methods of coping with some of these problems during the three most stressful periods-at time of diagnosis, when complications arise, and when treatment fails.

Induction of remission in acute leukemia ofchildhood by combination of prednisone and either 6-mercaptopurine or methotrexate

A controlled study of two chemotherapeutic induction regimens in the treatment of229 patients with acute leukemia of childhood is reported. The efficacy of a combination of prednisone and 6-mercaptopurine was compared to that of prednisone and methotrexate. Complete bone marrow remission in cases of acute lymphoblastic and undifferentiated leukemia was obtained in 86 per cent with prednisone and 6-mercaptopurine and in 80 per cent with prednisone and methotrexate. In the other types of acute leukemia, marrow remissions were noted in only 33 per cent with the former, and 22 per cent with the latter regimen.

Tuberculous dactylitis in childhood; a prognosis.

Summary 1. Twenty-one patients with tuberculous dactylitis complicating primarytuberculous infections in childhood were followed until death or to date (an average of eleven years). 2. Fourteen, or two-thirds of the patients, were 2 years of age or less when this complication occurred. Sixteen were negro and five were white. Eleven had dactylitis as a minor complication of a severe generalized tuberculosis, ten had dactylitis as part of a relatively mild infection. 3. The dactylitis was the presenting complaint in eleven patients. 4. The bones of the hands were involved eight times more frequently than those of the feet. The proximal phalanx of the index and middle fingers were the bones most frequently involved. 5. Provided the patient survived the other manifestations of tuberculosis, the prognosis for complete healing of the bone with return to normal contour in most instances was excellent. Healing occurred in from one to three years.

The team approach to the management of pediatric cancer

The last 20 years have witnessed remarkable improvements in the prognosis of children with many forms of malignant disease. The reasons for these improvements relate not only to the development of better drugs and more effective radiotherapy, but also to the multidisciplinary approach involving surgeon, chemotherapist, radiotherapist and immunotherapist in providing optimum treatment for the child with a particular cancer. In this paper, the changing role of the pediatric oncologist, surgeon and radiotherapist in improving the management of pediatric cancer is discussed.

The use of combination therapy in leukemia remission

The purpose of this study by Childrens Cancer Study Group A was to explore the effectiveness of combination chemotherapy in the remission maintenance of childhood leukemia. Sixty‐four children with leukemia underwent complete remission with varying doses of prednisone, vincristine, or a combination of 6‐mercaptopurine and methotrexate. They were then treated with 8‐week alternating courses of oral 6‐mercaptopurine and methotrexate. Midway in each course of 6‐mercaptopurine, intravenous actinomycin‐D was given. Similarly, intravenous nitrogen mustard was given during each course of methotrexate. The combination therapy was well‐tolerated. Significantly longer remissions were found in those patients induced with prednisone who received the combination chemotherapy (median = 720 days) when compared with 71 simultaneously treated controls (median = 406 days).

Leukemia in chiladhood: Introduction and etiology

Striking improvement in the treatment of certain childhood cancers during the past decade has resulted from a combined multidisciplinary approach utilizing surgery, irradiation, and chemotherapy early in the disease process. Early use of long‐term combination chemotherapy following definitive clinical and hematologic staging has resulted in significant “cure” rates in several diseases. The etiology of childhood leukemia remains unknown. Implicated have been viruses, genetic abnormalities leading to increased susceptibility, exposure to various chemicals, and at times obscure hereditary or familial factors. The recurrence of leukemia in donor cells in a leukemic child following bone marrow transplantation is reported for the second time.