Second neoplasms after acute lymphoblastic leukemia in childhood

Article Abstract:

Thirty years ago, the chances of survival for a child with acute lymphoblastic leukemia (ALL) were grim. Today, the situation has improved markedly, and 70 percent of children with ALL are likely to survive without disease recurrence. Much of this improvement is due to the realization that chemotherapeutic drugs do not enter the brain, and that a few leukemic cells hiding there provide the seeds of the almost inevitable relapse. Now that more children are surviving, however, there are also more opportunities for the development of long-term complications of the treatment procedures themselves. Of the various complications of cancer treatment, among the more serious is the development of a second form of cancer. A study was conducted of 9,720 children who had been diagnosed with ALL between 1972 and 1988. A total of 43 second neoplasms (cancers or tumors) could be identified among the long-term survivors of this group, seven times the number of neoplasms that would be expected in a group of this size and age. Twenty-four of these neoplasms were brain tumors, 22 times the expected number. All 24 of the patients who developed brain tumors had received radiation therapy to the head. There seems little doubt that the radiation therapy which saved their lives also contributed to the increased likelihood of developing a brain tumor. Research has now shown that the administration of chemotherapy directly into the cerebrospinal fluid is just as effective in curing ALL as radiation. However, since this is a more modern treatment, not enough time has elapsed to say with certainty that the risks of this form of treatment are smaller than those associated with radiation therapy. Other cancers found among the survivors include non-Hodgkin's lymphomas and thyroid cancer. The present study was not able to confirm previous reports of an excess number of acute non-lymphocytic leukemias among the ALL survivors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Causes of, Complications and side effects, Prognosis, Radiotherapy, Brain tumors, Lymphoblastic leukemia in children, Acute lymphocytic leukemia

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Successful reinduction therapy with amsacrine and cyclocytidine in acute nonlymphoblastic leukemia in children: a report from the Childrens Cancer Study Group

Article Abstract:

Great strides have been made in the chemotherapy for leukemia. However, treatment remains problematic for patients who failed to respond to chemotherapy or patients who have relapsed (recurrence of disease) following chemotherapy. One new drug which may prove useful for the reinduction of response to chemotherapy in patients with relapsed acute nonlymphoblastic leukemia is amsacrine. The drug, also potentially useful for patients who failed to respond to initial induction therapy, shows activity against this disease both alone and in combination with other drugs. A study was undertaken to evaluate the combination of amsacrine and cyclocytidine in 96 patients who had failed or relapsed after previous chemotherapeutic treatment. Fifty-two of these 96 patients were able to achieve complete remission (absence of symptoms of disease) as a result of this treatment, including 15 of 33 patients who had failed to achieve a satisfactory response to initial chemotherapy. Thirty-nine patients in the present study proved to have disease resistant to anthracycline chemotherapeutic drugs; 18 of these patients achieved a complete response to chemotherapy with amsacrine and cyclocytidine. The most common toxic effect of the treatment was nausea and vomiting, and there were no signs of toxicity to the heart, which may result from amsacrine treatment. Forty percent of the patients experienced serious infections resulting from the chemotherapeutic suppression of bone marrow. The average duration of the remissions achieved, however, has been disappointing. The median time to relapse in the present study was 98 days. Three patients remain alive without evidence of disease at least three years since the beginning of treatment, although two of these three received bone marrow transplantation after participating in the present study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Chemotherapy, Leukemia in children, Amsacrine

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