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Dive into the research topics where Margaret P. Sullivan is active.

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Featured researches published by Margaret P. Sullivan.


Cancer | 1973

Factors influencing survival in pediatric acute leukemia. The SWCCSG experience, 1958–1970

Stephen L. George; Donald J. Fernbach; Teresa J. Vietti; Margaret P. Sullivan; Daniel M. Lane; Mary Ellen Haggard; D. H. Berry; Derrick Lonsdale; Diane M. Komp

From 1958 through 1970 a total of 1,024 patients was entered on the 7 clinical studies of the Southwest Cancer Chemotherapy Study Group for newly diagnosed cases of acute leukemia. A review of these cases was undertaken to determine the important factors, other than therapy, influencing survival. The most important variables in terms of survival prognosis were found to be age at diagnosis, histologic type of leukemia, and initial peripheral blood leukocyte count. The influence of these variables appeared to persist for at least 5 years following diagnosis. Based on these variables, a simple heuristic approach was taken to define prognostic groups of patients. The patients race, initial platelet count, hemorrhagic status, and enlargement status of liver, spleen, and nodes were of additional prognostic value, but there appeared to be no prognostic significance in the patients sex, initial hemoglobin value, or percent of blast cells in the bone marrow.


Cancer | 1985

Pediatric oncology group experience with modified LSA2-L2 therapy in 107 children with non-Hodgkin's lymphoma (Burkitt's lymphoma excluded)

Margaret P. Sullivan; J. Boyett; Jeanette Pullen; William M. Crist; Edmond J. Doering; Robert C. Trueworthy; Eva Hvizdala; Frederick B. Ruymann; C. Philip Steuber

From September 1976 to August 1979 the Pediatric Oncology Group accessed 145 children to study the effectiveness of modified LSA2‐L2 therapy for the treatment of non‐Hodgkins lymphoma (NHL). Burkitts lymphoma patients were ineligible; E‐rosette‐positive patients with ≥ 25% blasts in the marrow entered after February 1977 were reported separately. Radiotherapy could be used to treat patients with compressive mediastinal disease at diagnosis and was prescribed for those with residual abdominal disease as demonstrated by second‐look surgery on completion of induction chemotherapy. Confirmation of diagnosis by the Pathology Panel and Repository Center for Lymphoma Clinical Trials was mandatory. Diagnostic tissues of 131 patients were reviewed. Among 107 evaluable patients, 91 (85%) achieved complete remission. Differences in response rates among the three major histologic groups (lymphoblastic, undifferentiated, and large cell) were of statistical significance, with response being poorest for diffuse undifferentiated lymphoma (P = 0.03). Failure‐free survival did not differ significantly for the three major histologic diagnoses. While response rate was lowest for Murphy Stage III patients (79%), the differences among the stages were not significant. Stage was not a significant prognostic factor for failure‐free survival (P = 0.08). The number of patients still at risk and the Kaplan‐Meier estimate of percentage of patients remaining at risk after 3 years is: Stage I, 8 (100%); Stage II, 10 (67%); Stage III, 28 (57%); Stage IV, 6 (39%); and > 25% blasts, 1 (13%). Stage III failure curves for lymphoblastic disease show continuing stepwise failure through 3 years. Among patients with diffuse large cell and undifferentiated disease, most failures occurred by 8 months. M1 and M2 levels of marrow involvement were not prognostic among children with lymphoblastic disease. The presence of a mediastinal mass was a significant factor contributing to failure in children with lymphoblastic disease without marrow involvement. Leucocytosis > 10,000/1, was a significant (P = <0.001) factor predicting failure‐free survival for patients with large cell lymphoma. The delivery of radiotherapy was not a significant factor in achieving remission. No consistent benefit resulted from using radiotherapy to treat postinduction residual disease demonstrated on second‐look exploration. The LSA2‐L2 regimen was associated with considerable toxicity, severe or worse in 77% and life‐threatening to 40% of these patients. Four died of toxicity. However, therapy was given more easily and safely as investigator experience increased. Maintenance therapy was delivered on an out patient basis without complications in most instances. This study demonstrates the ability of the LSA2‐L2 regimen to produce long‐term remissions, or to “cure” 60% to 70% of children among the major histologic categories of childhood NHL, excepting Burkitts lymphoma. Long‐term survival, or “cure”, occurs in 90% with Stages I and II disease and some 50% of those with Stages III and IV disease. Neither radiotherapy nor second‐look surgical procedures appear to influence outcome. The continuous relapse pattern seen in lymphoblastic disease involving the mediastinum suggests the need for more intensive repetitive therapy “up‐front”. The relapse pattern of non‐lymphoblastic disease suggests the discontinuation of therapy after 1 year.


Cancer | 1981

Occult testicular leukemia: Testicular biopsy at three years continuous complete remission of childhood leukemia: A Southwest Oncology Group study

Frederic B. Askin; Vita J. Land; Margaret P. Sullivan; Abdelsalam H. Ragab; Charles P. Steuber; Paul G. Dyment; J. Talbert; Terence N. Moore

Between June 1977 and December 1978, occult testicular leukemia (OTL) was discovered at three years of continual complete remission (CCR) from the time of diagnosis of acute lymphoblastic leukemia (ALL) in 5 of 59 (8.5%) of males undergoing bilateral wedge testicular biopsy at 1 of 15 participating Southwest Oncology Group (SWOG) institutions. Forty‐six of the 54 males with normal biopsies (78% of the total group of 59) have remained free of recurrent ALL at a median of 18 months (range 13 to 23 months) since the biopsy procedure, whereas eight have relapsed for the first time—five bone marrow (BM), one sclera, one simultaneous BM and testes, and one testes—at a median of 12.5 months (range 4 to 22 months) after the normal testicular biopsy. With aggressive therapy after biopsy in the five boys with OTL, one has died 19 months after biopsy (after two BM relapses), one is alive 21 months after biopsy (after two BM relapses), and three are alive and free of recurrent ALL 13, 16, and 19 months, respectively, since the diagnosis of OTL.


Journal of Clinical Oncology | 1985

Curability of Burkitt's lymphoma with high-dose cyclophosphamide-high-dose methotrexate therapy and intrathecal chemoprophylaxis.

Margaret P. Sullivan; Irma Ramirez

Twenty-four children with Burkitts lymphoma were treated beginning May 1976 with a regimen alternating high doses of cyclophosphamide and methotrexate in induction and consolidation; only high doses of methotrexate were used in the maintenance phase. Throughout therapy, which was planned for 54 weeks, intrathecal chemoprophylaxis using methotrexate, cytosine arabinoside, and hydrocortisone was coordinated with the high-dose methotrexate infusion therapy to provide CNS chemoprophylaxis that maintained therapeutic methotrexate spinal fluid levels (greater than 10(-6) mol/L) for approximately 60 hours. Twenty-two (92%) of the 24 children attained complete remission; two (8.3%) patients attained only partial remission, failing therapy. Two children died of infection while in complete remission; two children relapsed on therapy. Actual survival is 75%; the median follow-up time is 38+ months (range, 1 1/2+ to 84+ months). Relapses correlated with Murphy disease stage as follows: stage I--0/3, stage II--2/7, stage III--2/10, and stage IV--0/2. Serious side effects and toxicities of chemotherapy occurred in ten patients (metabolic disturbances after rapid tumor lysis, two; infectious and/or febrile episodes following cyclophosphamide therapy, three; methotrexate side effects, four; and complications of intrathecal therapy, one). Results of this therapy are similar to those of the best regimens that have been reported. Treatment has been adapted for use in Burkitts lymphoma by the Pediatric Oncology Group; the responsiveness of other B cell lymphomas of childhood to this treatment is also being determined.


Cancer | 1975

Adjuvant chemotherapy in primary treatment of osteogenic sarcoma.A southwest oncology group study

Wataru W. Sutow; Margaret P. Sullivan; Donald J. Fernbach; Ayten Cangir; Stephen L. George

A four‐drug adjuvant chemotherapy regimen (CONPADRI‐I) was utilized in the primary treatment of 18 children with osteogenic sarcoma. All patients had surgical amputation for the primary lesion. The children then received cyclophosphamide, vincristine, melphalan, and adriamycin in defined combinations intermittently over a 72‐week period. Of the 18 patients, 10 (55%) remain free of disease 24 months or longer from time of amputation.


Cancer | 1977

New assessment of the prognostic significance of histopathology in Hodgkin's disease for laparotomy‐negative stage I and stage II patients

Lillian M. Fuller; Hywel Madoc-Jones; Jess F. Gamble; James J. Butler; Margaret P. Sullivan; Carlos H. Fernandez; Edmund A. Gehan

This paper describes preliminary radiotherapy results in 90 patients with Stage I and II Hodgkins disease who were evaluated by laparotomy, including splenectomy, and liver and bone marrow biopsies. As a result of selection by laparotomy, the estimated five‐year survival rate for these patients was 96%. No statistically significant differences were detected in the disease‐free survival for patients with mixed cellularity, nodular sclerosis, and lymphocytic predominance disease. Since only one patient with lymphocytic depletion was in this series, no statement can be made regarding this rare histopathology. Patterns of new disease differed for Stage I and II patients. The major difference was that patients with nodular sclerosing Stage II presentations involving the mediastinum were at considerable risk of developing subsequent disease in the pulmonary parenchyma or the pleura. This finding, together with the demonstration that a histologic diagnosis of mixed cellularity did not carry an inferior prognosis, indicates the need for reassessment of the appropriateness of applying treatment programs based on results of lymphangiographically staged patients to Stage I and II patients evaluated by laparotomy.


Cancer | 1991

Clinical characteristics and treatment outcome of children with acute lymphocytic leukemia and Down's syndrome. A Pediatric Oncology Group study.

Abdelsalam H. Ragab; Aly Abdel-Mageed; Jonathan J. Shuster; Lawrence S. Frankel; Jeanette Pullen; Jan Van Eys; Margaret P. Sullivan; James M. Boyett; Michael J. Borowitz; William M. Crist

Of 2947 children with acute lymphocytic leukemia (ALL), treated during three consecutive studies of the Pediatric Oncology Group (1974–1986), 52 (1.8%) had Downs Syndrome (DS). Comparison of clinical and laboratory characteristics showed no significant differences in leukocyte count, racial distribution, sex ratio, platelet count, incidence of mediastinal mass, lymphadenopathy or hepatosplenomegaly, or percentage of blood or bone marrow blasts for children with ALL with or without Downs Syndrome (DS‐ALL or NDS‐ALL, respectively). However, children with DS‐ALL were slightly older at the time of presentation and had higher hemoglobin values. The relative frequency of each major immunophenotype (early pre‐B, pre‐B, T, or B) was also comparable for patients with or without DS. For this report, treatment regimens were categorized as either conventional (no consolidation therapy) or intensive. Cox regression analysis revealed that the presence of DS, a higher leukocyte count, black race, or age older than 10 years was independently associated with a poorer event‐free survival (EFS) for children treated with conventional chemotherapy. However, for the cohort of children who received intensive chemotherapy, DS was no longer an independent risk factor. In fact, event‐free survival (EFS) was markedly improved to a level comparable with that observed in the children diagnosed as having NDS‐ALL. On the other hand, serious toxicity, requiring interruption of treatment, was significantly more frequent in the intensively treated children with DS compared with similarly treated patients with NDS‐ALL, although deaths resulting from toxicity occurred infrequently.


Cancer | 1980

Radiotherapy (2500 rad) for testicular leukemia: Local control and subsequent clinical events: A southwest oncology group study

Margaret P. Sullivan; Carlos A. Perez; Jay Herson; Mario Silva-Sousa; Vita J. Land; Paul G. Dyment; Rafael Chan; Alberto G. Ayala

The effectiveness of radiotherapy, 2500 rad over two weeks, in treating leukemic infiltrates of the testicles was studied in 38 boys who met the requirements for tissue confirmation of testicular involvement and examination of the bone marrow. The study group was heterogeneous with respect to specific histology and prior therapy. Complete regression of testicular infiltrates was confirmed by repeat biopsy examinations of 32 of 33 patients undergoing the procedure. The single treatment failure occurred in a boy with acute myelogenous leukemia. In all other patients, local disease control following radiotherapy persisted throughout the remainder of the clinical course. Three of 5 children, however, showed evidence of reseeding of the testicle as a part of the relapse process at post‐mortem examination. Statistical analysis of data from the 35 patients with acute lymphocytic leukemia showed the subsequent course of the disease with respect to next relapse, involving either bone marrow (BM) or the central nervous system (CNS), to be dependent on the acute leukemia prognostic group, as determined by age and peripheral white blood cell count (WBC) at the time of diagnosis, and timing of extramedullary disease (EMD). Patients with poor prognosis at the time of diagnosis and EMD afterward had a 3.8 times greater risk of a subsequent BM or CNS relapse than did patients with good or average prognosis and no EMD at any time (P = 0.07). Of the candidate prognostic factors examined with respect to survival, only the number of prior BM relapses was of statistical significance (P = 0.044). Children with two or more prior BM relapses had the worst prognosis for survival from testicular relapse, with a death risk of 3.6 times greater per unit of time than that of children with no or one prior BM relapse. Protective BM and CNS rescue therapy was recommended for those otherwise in complete remission (CR) at the time of testicular relapse. The median times to next relapse for patients receiving both BM and CNS rescue therapy and for patients given CNS rescue only were 42+ and seven weeks, respectively (P = 0.09). The type of rescue received did not appear to affect survival time following testicular CR. Cancer 46:508–515, 1980.


Cancer | 1989

Diffuse small noncleaved cell lymphoma in children, Burkitt's versus non-Burkitt's types. Results from the Pediatric Oncology Group and St. Jude Children's Research Hospital.

Robert E. Hutchison; Sharon B. Murphy; Diane L. Fairclough; Jonathan J. Shuster; Margaret P. Sullivan; Michael P. Link; Sarah S. Donaldson; Costan W. Berard

The clinical relevance of a morphologic distinction between Burkitts (B) and non‐Burkitts (NB) types of small non‐cleaved cell (SNC) non‐Hodgkins lymphoma (NHL) has been controversial. Numerous attempts to discern an important clinical difference between the subtypes have failed to provide a convincing reason to maintain this distinction for other than descriptive purposes. Because of conflicting reports in the literature, the authors have analyzed 183 cases of SNC NHL in children from the Pediatric Oncology Group and 129 from St. Jude Childrens Research Hospital (Memphis, TN). The results from both series, which consist of approximately the same proportions of B and NB subtypes, (i.e., approximately 54%–58% B, 36% NB, and 6%–10% not otherwise specified) show no significant differences in age at presentation, extent of disease, primary site of involvement, or survival. The authors conclude that the morphologic distinction between B and NB types of SNC NHL in children lacks demonstrable clinical importance.


Cancer | 1987

A morphologic study of childhood lymphoma of the lymphoblastic type: the pediatric oncology group experience

Rogers C. Griffith; David R. Kelly; Bharat N. Nathwani; Jonathan J. Shuster; Sharon B. Murphy; Eva Hvizdala; Margaret P. Sullivan; Costan W. Berard

For this study 227 non‐Hodgkins lymphomas, registered through the Pediatric Oncology Group clinical studies between 1976 and 1982, were morphologically subclassified into major histologic types and subtypes, and their histopathologic and clinical features were compared. These lymphomas were distributed primarily into only three of the recognized major histologic types: lymphoblastic (LB), 106 (47%) undifferentiated (DU), 49 (21%); and diffuse histiocytic (DH), 72 (32%). These patient groups were found to differ in several ways: (1) the LB lymphomas contained most of the patients under two years of age; (2) the LB lymphomas tended to present in higher clinical stages; (3) the LB lymphomas tended to involve lymph node groups and the bone marrow more often than did the DU and DH lymphomas; and (4) the DU lymphomas had a greater tendency for gastrointestinal tract and other major organ system involvement. The complete remission rate of 96%, for the LB lymphomas was better than for either the DU or the DH lymphomas. The disease‐free survival of the LB lymphomas was significantly better than the DU group, but not the DH group. The LB were histologically divisible into three subtypes: convoluted (C), nonconvoluted (NC), and large cell variant (LCV). The C and NC subtypes preferentially involved the mediastinum and peripheral lymph nodes initially, while the LCV tended to involve the abdomen. However, none of the subtypes differed in clinical stage. The complete remission, and the disease‐free survival rates between these subtypes were not statistically different. Cancer 59:1126‐1131, 1987.

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Wataru W. Sutow

University of Texas MD Anderson Cancer Center

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Ayten Cangir

University of Texas MD Anderson Cancer Center

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Teresa J. Vietti

Washington University in St. Louis

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Irma Ramirez

University of Texas MD Anderson Cancer Center

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Costan W. Berard

St. Jude Children's Research Hospital

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Eva Hvizdala

University of South Florida

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Grant Taylor

University of Texas at Austin

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James J. Butler

University of Texas System

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Jeanette Pullen

University of Mississippi

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