Steven J. Culbert

Outpatient treatment of fever and neutropenia for low risk pediatric cancer patients

Fever and neutropenia (F&N) is a common complication of cancer chemotherapy. It is conveniently managed by hospitalization and empiric administration of parenteral antibiotics. This study attempted to determine whether pediatric cancer patients with F&N identified as low risk for morbidity and mortality by clinical criteria at the time of presentation could be treated safely as outpatients.

Economic and resource utilization analysis of outpatient management of fever and neutropenia in low-risk pediatric patients with cancer

PURPOSE To measure resource allocation in outpatient management of fever and neutropenia in low-risk pediatric patients with cancer and its impact on their families. PATIENTS AND METHODS A prospective clinical trial was conducted. Eligible patients received a single dose of intravenous (IV) antibiotics and were observed for several hours in clinic. Patients were randomly assigned to continue either IV or oral antibiotics and were seen daily as outpatients. Charges were calculated based on the number of resources used and Medicare/Medicaid reimbursement schedules. A questionnaire was used to measure the impact of outpatient treatment on the family. RESULTS Seventy-three episodes of fever and neutropenia were studied. The median duration of treatment was 4 days. Eighty-six percent of the episodes were managed without hospitalization. The median calculated charge was

Ethnicity and cure rates of Texas children with acute lymphoid leukemia

1840. The median calculated charge for patients receiving oral antibiotics was

Fractionated high-dose cyclophosphamide for advanced pediatric solid tumors

1544 and was significantly less than the

Season-Of-Birth and Acute Leukemia of Infancy

2039 median charge for outpatients treated with IV antibiotics. The estimated charge for comparable inpatient treatment was

236 PHARMACOKINETICS OF AMIKACIN IN CHILDREN WITH MALIGNANCIES

4503. Nearly all families preferred outpatient care, and few reported a loss of work hours or increased child care expenses. CONCLUSIONS Outpatient treatment of low-risk episodes of fever and neutropenia is substantially less costly than inpatient care and is preferred by most families.

Spontaneous remission of granulocyte colony-stimulating factor–associated leukemia in a child with severe congenital neutropenia

Ethnic differences in the survival of children treated for acute lymphoid leukemia (ALL) have been described in several locations. Children of African, Polynesian, Native American, and Mexican ancestry had a less favorable outcome than children of European ancestry when treated in a similar manner by the same physicians and nurses.

IMMUNOMAGNETIC REMOVAL OF CALLA POSITIVE CELLS FROM HUMAN BONE MARROW

Purpose The objective of this study was to determine the tolerance and toxicities of high-dose cyclophosphamide (CPA) at 7 g/m2 given in four fractions over 8 h in children with advanced solid tumors. Patients and Methods Twenty children aged 1 1/2–19 years (median, 12 years) received 24 courses of high-dose CPA at 7 g/m2 for the treatment of advanced malignant solid tumor. CPA was given in four 1-h infusions of 1.75 g/m2 each, with 1 h of rest between each dose. MESNA was used as a uroprotective agent and was continued for 24 h after the final dose of CPA. With only one exception, all patients were discharged at the end of MESNA infusion and received granulocyte colony-stimulating factor, prophylactic ciprofloxacin, and co-trimoxazole. Results Severe but transient myelosuppression was observed. The median time to neutrophil and platelet recovery was 17 and 19 days, respectively. Fever developed after 13 of the 24 courses, and hospitalization was required. Extramedullary toxicities were mild. No patient showed cardiomyopathy or hemorrhagic cystitis. Forty-six percent of the courses were managed entirely on an outpatient basis. Objective tumor response was seen in five patients. Conclusions CPA at 7 g/m2 is well tolerated by children with advanced malignancies and should be considered in earlier phases of antineoplastic therapy.

Severe Osteopenia in a Young Boy With Kostmann's Congenital Neutropenia Treated With Granulocyte Colony-Stimulating Factor: Suggested Therapeutic Approach

Because of its short and clearly delineated latency period, acute leukemia of infancy is particularly suited to etiologic analysis. From 1950 to mid-1985, 31 infants with acute leukemia (less than 1 year of age) were registered at the University of Texas, M.D. Anderson Cancer Center at Houston. The medical records of these infants were reviewed for demographic and birth information. Of the 31 infants, 14 (45%) were Hispanic. The sex ratio was 3:1 male/female) for white infants and 5:9 for Hispanic infants. Of the white infants, half had acute lymphocytic leukemia, compared with all but one of the Hispanic infants. There was a significant excess of winter births among the infants diagnosed with acute leukemia (P less than 0.05). The significant association between season-of-birth and the occurrence of leukemia cases is suggestive of periodicity of an environmental etiologic agent, perhaps acting in concert with endogenous rhythmicities in susceptibility to that agent. This finding is deserving of further study.

Remission induction and continuation therapy in children with their first relapse of acute lymphoid leukemia. A pediatric oncology group study

Amikacin is an aminoglycoside antibiotic that is effective against gram negative bacilli which are resistant to other aminoglycoside antibiotics. Pharmacokinetic data of amikacin in pediatric patients are scant. The pharmacokinetics of amikacin were evaluated in 30 hospitalized children (5 to 14 years of age) with malignancies. Children receiving 15 or 20 mg/kg/24 hr administered every 8 to 6 hours, respectively had peak serum concentrations of 16.9±3.67 μg/ml (mean ± SD) at the end of a one hour infusion. Six and 8 hour serum concentrations were 1.27±1.26 and 0.64±0.92 μg/ml, respectively. The t½ was 78±43.8 minutes and the total clearance was 133±43 ml/min/1.73 m2. The mean volume of distribution was 0.26±0.08 1/kg. No accumulation of amikacin was noted and no side effects occurred. A 9% inactivation of amikacin occurred when incubated in normal donor sera at 37°C for 72 hours with varying concentrations of ticarcillin. Due to the rapid renal clearance and short half life of amikacin in these children, the currently recommended dose of amikacin should be increased and the frequency of administration shortened.