Kozo Nishimura

High frequency of etoposide (VP-16)-related secondary leukemia in children with non-Hodgkin's lymphoma.

Patients and Methods : We report patients who were treated for non-Hodgkins lymphoma (NHL) or Ki-1 antigen-positive (Ki-1) lymphoma with a T-8801 protocol that included etoposide (VP-16) and behenoylcytosine arabinoside. Results : Secondary acute myeloid leukemia (AML) developed in 5 of 38 NHL and Ki-1 lymphoma patients, and the cumulative risk at 4 years was 18.4%. The median time from the initiation of the chemotherapy to the development of AML was 21 months (range, 13–30). Four patients had a FAB M5 morphology, and one had FAB M2. In four of five examined cases, chromosomal alterations involving the long arm of chromosome 11 were demonstrated at the time of development of AML. None of the 46 NHL patients who we treated with another protocol (B-8801), using significantly higher cumulative doses of VP-16 than in the case of the patients with T-8801 and a different schedule of VP-16 administration, developed secondary AML. Conclusions : The risk of secondary AML possibly related to the use of VP-16 given twice weekly.

Treatment of Acute Lymphoblastic Leukemia in the Tokyo Children's Cancer Study Group—Preliminary Results of L84-11 Protocol

The Tokyo Childrens Cancer Study Group (TCCSG) has performed prospective randomized controlled studies since 1984 for childhood acute lymphoblastic leukemia (ALL). Four hundred and ninety‐eight newly diagnosed patients were treated with 5 different regimens designated as SI, S2 for a standard risk group (SRG), HI and H2 for a high risk group (HRG) and HEX for a extremely high risk group of patients. We added intermediate‐dose methotrexate as early intensification therapy in the S2 and H2 groups to reduce extramedullar and medullary relapses. Event‐free survival of all patients at 4 years 6 months from the start of this regimen (median follow‐up period 32 months) was 67.5%. The CNS relapse rate was significantly decreased to 2.2% compared to previously reported studies and our own experience. There were some unexpected complications of the CNS such as myelopathy and/or leukoencephalopathy. For the SRG early ID‐MTX seemed to be useful to improve the prognosis, but triple intrathecal injections (TIT) should be limited in number. The 24Gy cranial irradiation (CRX) was effective but possibly excessive for the HRG. As evidenced by the success of the HEX group regimen, more intensive multi‐drug consolidation in the early post‐remission phase might be necessary to improve further the prognosis and to make it possible to shorten the treatment periods.

Principles of Total Care for Children with Leukemia —Psychosocial Interventions —

Today about 70% of children with leukemia are cured by intensive chemotherapy. Therefore how to deal with the children and their families before, during, and after the treatment has become a major concern for caregivers. And it is a fact that there are still a few patients who relapse and are destined to die. We are now taking care of two groups of patients. One group is truly cured and one group is dying. We have been trying to establish a good total care system that fits our society. We have formed medical teams which consist of doctors, nurses, and care workers. From our experience, we think the most important principle for the caregivers is frankness. Sometimes this is very difficult. Other important points of total care, especially from psychosocial aspects, are mentioned.

A case report of Stevens-Johnson syndrome with Mycoplasma pneumoniae infection

We encountered an 8 year old boy who suffered from Stevens‐Johnson syndrome with Mycoplasma pneumoniae infection. He had multiple erythema with vesicles in oral mucosa, and on his palms and feet, trunk and genital regions. We treated him with prednisolone (1 mg/kg per day) and antibiotics. His skin lesions improved dramatically, and a persistent fever and toxic general condition also showed dramatic improvement.

Difficulty in removing a percutaneous central venous catheter inserted from a peripheral vein

Two girls with acute lymphocytic leukemia (ALL) are reported. There were difficulties in removing their central venous catheters inserted from a peripheral vein. One girl required surgery under general anesthesia for the removal. The other patient received continuous infusion of low dose urokinase from a distal peripheral vein. The residual catheter was then removed successfully.

Torsion of Ovary with Leukemic Infiltration

Currently advanced chemotherapy for acute leukemia in children has brought many long term survivors. Consequently, the incidence of extramedullary leukemia such as CNS leukemia, leukemic retinopathy and gonadal invasion has become more frequent. Ovarian leukemia is, however, less frequently reported compared with testicular involvement. Although treatment and prophylaxis for this complication are not uniformly established thus far [ 1, 21, the use of sonography and/or computed tomography in evaluating the ovarian invasion is recommended [ 3-5 3 . This report is of a 6-year-old-girl with acute lymphoblastic leukemia (ALL) who developed bvarian torsion with leukemic invasion during bone marrow remission.

Kawasaki Disease and Agranulocytosis

Kawasaki disease associated with agranulocytosis was observed in a one‐year‐old girl. The agranulocytic state continued for a month, and granulocyte transfusions were required. We discuss the relation between agranulocytosis and drugs, viral infections, Kawasaki disease, etc. The systemic vasculitis of Kawasaki disease seems to be the cause of the bone marrow disturbance.