Multiagent chemotherapy in relapsed acute lymphoblastic leukemia in children
Article Abstract:
Although improvements in the treatment of acute lymphoblastic leukemia (ALL) have resulted in greatly increased survival, 40 percent of children with ALL will eventually die of the disease. A study was undertaken of a chemotherapeutic regimen involving several agents to determine if improvements could be achieved in the treatment of children who had relapsed after their initial round of chemotherapy. Twenty-seven children were treated with a regimen that consisted of 35 days of therapy with daunomycin, vincristine, and prednisone, followed by teniposide and cytosine arabinoside. At 35 days, a bone marrow specimen was taken to monitor the progress of the therapy. Regardless of the results of the bone marrow sampling, however, the patients were immediately begun on a 21-day regimen of consolidation therapy consisting of methotrexate, hydrocortisone, and cytosine arabinoside injected directly into the subarachnoid space. Another bone marrow specimen was obtained at 56 days after the start of therapy. Maintenance therapy was continued for two years. A total of 23 patients achieved remission. However, the five patients who had achieved remission by day 56, but had not yet achieved remission at day 35 were found to fare less well than those who had clean M1 specimens on day 35. (M1 marrow is defined as having a percentage of blast cells of less than five percent.) All these patients had relapsed by 15 months. In contrast, among the patients who had achieved clean M1 marrow by day 35, event-free survival was 64 percent at 12 months and 32 percent at 4 years. The 32 percent survival appears to be a plateau which was established at about 30 months. However, it is to be expected that some of these patients will nevertheless experience relapse at some future date. Although the number of patients in this study is small, the 85 percent remission rate achieved in this study compares favorably with other published reports, in which 80 percent remission seems to be about the best achieved in the reinduction of remission in children who had already relapsed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
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The coagulopathy of childhood leukemia: thrombin activation or primary fibrinolysis?
Article Abstract:
Some cancer patients have a coagulopathy, or abnormality in the blood clotting system. This abnormality often reveals itself by the formation of clots within the blood vessels of these patients. However, since cancer patients are often suffering from numerous systemic disturbances, secondary to their cancer and its treatment, it is difficult to determine the actual prevalence of coagulopathy and to evaluate the defects which might lead to this condition. To circumvent some of these difficulties, factors involved in the clotting process were examined in 102 children who had been recently diagnosed with acute leukemia. Fifteen percent of the children were found to have severe coagulopathy on initial examinations. Measurements suggested that the coagulopathy was due to thrombin activation. When activated, thrombin enzymatically converts fibrinogen to fibrin, forming the clot. Although thrombin may be activated by tissue factor, the researchers found no evidence of elevated tissue factor in these leukemia patients. The results demonstrate that the coagulopathy observed in children with leukemia is due to thrombin activation, but the mechanism of this activation is still uncertain. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
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