Paul G. Dyment

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

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.

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

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.

Phase I trial of indicine-N-oxide in children with leukemia and solid tumors: a Pediatric Oncology Group study

SummaryA phase I trial of indicine-N-oxide was carried out in 12 children with solid tumors and in 16 with leukemia. Doses of 5, 6, and 7.5 g/m2 were given parenterally as a 15-min infusion every 3 weeks. The maximum tolerated dose in patients with solid tumors was 7.5 g/m2 and the dose-limiting toxicity was myelosuppression. In leukemia, the maximum tolerated dose was 6.0 g/m2 and hepatotoxicity was dose-limiting. Half of the children with leukemia showed elevations in transaminase levels and one child died of massive hepatic necrosis. This hepatotoxicity limits the use of indicine-N-oxide in children with leukemia. Antineoplastic activity was limited to a transient reduction in the numbers of circulating leukemic cells.

Streptozotocin (NSC‐85998) in Children with Acute Lymphocytic Leukemia. A Southwest Oncology Group Study

Streptozotocin (NSC-85998), a nitrosourea antibiotic, was given to 18 children with acute lymphocytic leukemia in relapse in a dose of 500 mg/m2/day intravenously every day for five days. There were no responses in 14 fully evaluable patients. The principal toxicity consisted of gastrointestinal disturbances. Based on our findings and those of others in adults, steptozotocin appears to play no role in the management of acute lymphocytic leukemia.