Medical and Pediatric Oncology (Med Pediatr Oncol)

Publications in this journal

• Article: Vm‐26 with prednisone and vincristine for treatment of refractory acute lymphocytic leukemia

  Gaston Rivera MD, W. Paul Bowman MD, Sharon B. Murphy MD, Gary V. Dahl MD, Rhomes J. Aur MD, David K. Kalwinsky MD, Adynel Wood PNP, Shirley Stagner PNP, Thomas L. Avery PhD
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  ABSTRACT: Fifty-six children with refractory acute lymphocytic leukemia (ALL) were assessed for remission-induction responses to VM-26 (250 mg/m2 per week) in combination with prednisone (40 mg/m2 per day) and vincristine (1.5 mg/m2 per week). Each child had been treated intensively with steroids, vincristine, daunorubicin and L-asparaginase. In fact, all patients had failed to respond to previous reinduction therapy with prednisone-vincristine or had relapsed while receiving vincristine. Our intent in this study was to test whether or not addition of VM-26 to prednisone-vincristine would overcome clinical resistance to these established agents. Complete remissions were induced in 17 patients (0.30) over 4 to 6 weeks. Five of these children, all clinically unresponsive to prednisone-vincristine alone, had complete remissions that lasted longer than 1 year; two remain in remission for 2 1/2 years and both are now off therapy. Myelosuppression, the most serious treatment complication, was documented in 20 of 26 evaluable patients. The median time to recovery of normal marrow function was 15 days. These results demonstrate further the potential of VM-26 in combined-drug treatment of refractory ALL. Whether the effectiveness of this combination represents potentiation of prednisone and vincristine activity by VM-26 or some other, as yet unidentified interaction, remains to be determined.
  Medical and Pediatric Oncology 04/2008; 10(5):439 - 446.
• Article: Letter to the editor: “Chemotherapy for Unresectable Pancreatoblastoma”

  Jeffrey D. Hord, Robert L. Janco
  Medical and Pediatric Oncology 03/2007; 26(6):432 - 433.
• Article: High‐dose cytosine arabinoside in the treatment of refractory acute nonlymphocytic leukemia in adults: Results of two six‐day regimens

  Roger H. Herzig MD, Geoffrey P. Herzig MD, Hillard M. Lazarus MD, Steven N. Wolff MD, Gordon L. Phillips MD
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  ABSTRACT: High-dose cytosine arabinoside (Ara-C) was used in adult patients with refractory acute nonlymphoblastic leukemia, either alone (3 g/m2 every 12 h X 12 doses) or with 3 additional days of anthracycline antibiotics. The systemic toxicities were similar for both groups without an increase in the group receiving anthracyclines. Bone marrow recovery was also similar for these groups. The antileukemic effect was not statistically increased in the group receiving anthracyclines, but when a comparison of the complete remission late in resistant patients is made, there is a trend toward a greater number of complete remissions when anthracyclines are included in the regimen (p = 0.09). High-dose Ara-C is effective therapy for refractory leukemia; the addition of anthracyclines may enhance the effect of the Ara-C.
  Medical and Pediatric Oncology 07/2006; 10(S1):229 - 233.
• Article: Editorial: Towar an understanding of the childhood histiocytoses

  Giulio J. D'Angio MD, Blaise E. Favara MD, Stephan Ladisch MD
  Medical and Pediatric Oncology 07/2006; 14(2):104 - 104.
• Article: Re: “Letter to the editor: Increased risk of cardiac dysfunction after anthracyclines in girls”

  Frances A. Bu'Lock MA, BM, BChir, MRCP, Robin P. Martin, Martin G. Mott
  Medical and Pediatric Oncology 07/2006; 24(2):143 - 144.
• Article: Alveolar soft‐part sarcoma

  R. Beverly Raney
  Medical and Pediatric Oncology 07/2006; 6(4):367 - 370.
• Article: Growth factors in lung cancer: Possible etiologic role and clinical target

  Karen Kelly MD, Madeleine A. Kane, Paul A. Bunn Jr
  Medical and Pediatric Oncology 07/2006; 19(6):449 - 458.
• Article: Chemotherapy for Retinoblastoma

  Les White
  Medical and Pediatric Oncology 07/2006; 24(5):341 - 342.
• Article: Letter to the editor:“Role of chemotherapy in pediatric pulmonary blastoma” by ozkaynak et al., 1990

  Albert N. Békássy, Inga Hägerstrand, Henrik Henrikson, Stanislaw Garwicz, Thomas Wiebe
  Medical and Pediatric Oncology 07/2006; 18(5):359 - 359.
• Article: Ifosfamide‐induced subclinical nephrotoxicity and its potentiation by cisplatinum

  Rainer Rossi MD, Sigrid Danzebrink, Dirk Hillebrand, Katrin Linnenbürger, Kurt Ullrich
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  ABSTRACT: Renal function was assessed in 72 children and adolescents 3.5 to 123 months after completion of chemotherapy employing ifosfamide (n = 39) or ifosfamide plus cisplatinum (n = 33). No patient had preexisting renal parenchymal disease. Whereas reduction in glomerular filtration rate was present in six of 69 patients (8.7%), impairment of tubular transport for phosphate, glucose, and amino acids was more frequent: 32.8% of the patients showed reduction in phosphate reabsorption, and glucose and amino acid reabsorption was lowered in 16.4% and 55.0%, respectively. Elevated sodium excretion was found only occasionally, and there was no evidence of renal tubular acidosis. Proximal tubular damage is related to ifosfamide chemotherapy, but correlation between ifosfamide dose and phosphate reabsorption was not linear. The most severe depletion of phosphate reabsorption was seen in patients treated with both ifosfamide and cisplatinum. On reexamination of phosphate reabsorption after a median interval of 8 months, the majority of patients with initially reduced values showed further deterioration of this function. © 1994 Wiley-Liss, Inc.
  Medical and Pediatric Oncology 07/2006; 22(1):27 - 32.
• Article: Undifferentiated acute leukemia and lineage infidelity (difficulties in classification and management)

  Cynthia A. Delaat MD, Beatrice Files MD, Richard E. Harris MD, Steven Neudorf MD, Beatrice C. Lampkin MD
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  ABSTRACT: The acute leukemias have been considered to represent a clonal expansion of a malignant transformed hematopoietic progenitor cell with adherence to either the myeloid or lymphoid lineage—“lineage fidelity.” Lineage fidelity has been challenged by the demonstration of lineage switching or mixed-lineage leukemias. We describe a 7 year old male who presented with undifferentiated acute leukemia and nasopharyngeal and cervical masses. His blasts had the morphologic appearance of myeloblasts (FAB M1) and were positive solely for the myeloid antigen CD15. He entered a complete remission (CR) with acute nonlymphocytic leukemia therapy. At first relapse he had evidence of mixed-lineage leukemia with B-cell lymphoid and myeloid phenotypes. He again relapsed from a second CR with Burkitt-cell leukemia. Cytogenetic findings showed a consistent 14q+,17p+ abnormality in the blasts and nasopharyngeal mass. The t(8;14) associated with Burkitt's lymphoma was found in the mass tissue only following passage in the nude mouse.Our patient demonstrates that limitations still exist in our ability to classify acute leukemia. That leukemic transformation occurred in a multipotential progenitor cell leading to undifferentiated leukemia at diagnosis and/or that chemotherapy can influence the genetic programs of leukemic cells leading to the evidence of mixed-lineage leukemia and lineage switching is supported.
  Medical and Pediatric Oncology 07/2006; 18(1):15 - 21.
• Article: Peritoneal metastases in two patients with pineoblastoma and ventriculo‐peritoneal shunts

  Sridharan Gururangan MRCP, Richard L. Heideman MD, Edward H. Kovnar MD, Robert A. Sanford MD, Larry E. Kun MD
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  ABSTRACT: We report the uncommon occurrence of ventriculo-peritoneal shunt-associated peritoneal metastases in two patients with pineoblastoma. In one patient, the peritoneal cavity was the only site of recurrence; there was no evidence of disease recurrence in the central nervous system. One other patient with recurrent intracranial disease had synchronous, but asymptomatic, peritoneal metastases which were detected on an elective ultrasound. Although rare, peritoneal metastases appear to respond well to systemic chemotherapy. Ultrasound surveillance of the abdomen should be considered as a part of the routine follow-up evaluation in patients with embryonal central nervous system tumors and ventriculo-peritoneal shunts. © 1994 Wiley-Liss, Inc.
  Medical and Pediatric Oncology 07/2006; 22(6):417 - 420.
• Article: Germ cell tumors in children: Gonadal and extragonadal

  Norma Wollner MD, Fereshteh Ghavimi MD, Antonio Wachtel MD, Enrique Luks MD, Philip Exelby MD, James Woodruff MD
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  ABSTRACT: Sixty-three pediatric patients with germ cell tumors are presented with details of symptoms, histological findings, staging, serological markers, treatment, and response to therapy. The primary sites were: ovarian 32, testicular 17, presacral 7, mediastinal 3, intraabdominal 2, vaginal 1, and right inguinal canal 1. These patients were treated with T2 (sequential use of dactinomycin, doxorubicin, vincristine, and cyclophosphamide, with or without radiation), T6 (combination chemotherapy with cyclo-phosphamide, bleomycin, dactinomycin, doxorubicin, methotrexate, vincristine), or VAB treatment protocols (velban, dactinomycin, bleomycin, cisplatin). The cure rate for stage I ovarian and testicular germ cell tumors was 100%; for stage III, all primary sites, 82% and for stage IV, all primary sites, 75%. Histology was prognostic in ovarian tumors of the immature malignant teratoma type; the neural type immature teratoma, grades II and III, had the worst prognosis. Initial debulking surgery in combination with chemotherapy and radiation plays an important role in germ cell tumors. Stages II, III, and IV germ cell tumors require aggressive treatment with surgery, radiation, and chemotherapy. For stage I patients, with primary ovarian malignant tumor, cure with surgery alone can be achieved in 50% of the cases and in testicular tumors in about 70% of the patients. For those with stage I and elevated serological markers, it is feasible to follow these markers and give no treatment until there is evidence of persistent elevation or a rise in titers after an initial fall. In those without elevated serological markers, one should take into consideration the size of the tumor and the histological type before taking the “wait and see” approach. These stage I tumors are highly curable when they first present but, if allowed to recur, chemotherapy may not offer the patient such a favorable response and cure rate.
  Medical and Pediatric Oncology 07/2006; 19(4):228 - 239.
• Article: Total body hyperthermia in combination with etoposide and melphalan in a child with acute myelomonocytic leukemia

  Rüdiger Wessalowski MD, Ulrich Willnow MD, PhD Herbert Jürgens MD, Herman Dehnen MD, PhD Ulrich Göbel MD
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  ABSTRACT: In vitro and clinical studies have shown antineoplastic effects of hyperthermia alone and in combination with other treatment modalities. Synergistic cytotoxic effects of chemotherapy and hyperthermia have been demonstrated on leukemic cell clones in vitro. It seems that hyperthermia is effective in overcoming chemotherapy resistance. Several groups treated solid tumors by using total body hyperthermia (TBHT). However, only a few studies have been reported investigating the clinical effects of TBHT in myeloproliferative disorders. We report the case of a 7-year-old boy with myelomonocytic leukemia treated with TBHT (2 hours, 42°) combined with etoposide (600 mg/m2), melphalan (30 mg/m2) and hyperglycemia (200-300 mg/dl). Within 24 hours after TBHT, the leukemic cells decreased after TBHT from 53,000/μl to zero. Skin leukemic infiltrates, resistant to conventional treatment, also responded well. Although our patient relapsed 34 days after TBHT, these results indicate that TBHT in combination with cytotoxic treatment may be a useful treatment modality in refractory leukemia.
  Medical and Pediatric Oncology 07/2006; 22(1):61 - 65.
• Article: Langerhans cell histiocytosis and acute leukemia: Unusual association in two cases

  Maurizio Aricò MD, Adele Comelli MD, Grazia Bossi MD, Emanuela Raiteri MD, Margherita Piombo MD, R. Maarten Egeler MD
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  ABSTRACT: Langerhans cell histiocytosis (LCH) is a non-malignant disorder, whether localized or disseminated, and usually has a favourable prognosis. A possible relationship between LCH and neoplastic diseases has not been assessed up to now even if a few cases have been recorded.We report two new cases of acute leukemia in children with LCH. The first child had acute lymphoblastic leukemia after untreated LCH; the second developed acute promyelocytic leukemia after LCH treated with vinblastine and etoposide. To our knowledge, this is the first case of secondary leukemia after exposure to an epipodophyllotoxin derivative in a child with benign disease.Cooperative studies of large numbers of LCH patients are needed to evaluate a possible association between LCH and acute leukemia, and to identify common risk factors or predisposing agents if such be present. © 1993 Wiley-Liss, Inc.
  Medical and Pediatric Oncology 07/2006; 21(4):271 - 273.
• Article: Training and oncologists' changing attitudes toward their own cancer therapy

  FACP Nathan Schnaper MD, Suezanne Tangerose Orr PhD, Margaret N. Wesley PhD, FACP Joseph Aisner MD
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  ABSTRACT: Oncologists' attitudes toward therapy for his or her own hypothetical cancer have not been studied, and they may influence therapeutic decisions for patients. This study compared attitudes of oncologists at different levels of training toward therapy for their own hypothetical cancer. Those with limited oncology experience had high expectations for treatment, as expressed in their acceptance of all therapeutic modalities for their own disease. Early intensive inpatient oncology experience (first year of training) led to disenchantment, and rejection of various therapies. Further outpatient experience led to an increased acceptance of therapy again, and those finishing second and third year of oncology training, and senior medical staff in oncology, had high expectations for treatment. These results suggest an evolution of attitudes toward therapy with training and experience.
  Medical and Pediatric Oncology 07/2006; 13(5):293 - 297.
• Article: Survival after retinoblastoma: Long‐term consequences and family history of cancer

  Julianne Byrne PhD, Thomas R. Fears PhD, Charles Whitney, Dilys M. Parry PhD
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  ABSTRACT: Retinoblastoma (Rb) is a rare childhood tumor of the eye. In the heritable form, tumors are often bilateral and survivors have a greatly increased risk both for a second malignancy and for having children with Rb. Familial patterns of both cancer and birth defects are poorly understood in families with a heritable cancer, and little is known of the ways that a heritable cancer affects the lives of long-term survivors. To find out more about these and other issues in the lives of long-term survivors of childhood and adolescent cancer, we interviewed 56 adult survivors of retinoblastoma (15 with the heritable form) and 84 brothers and sisters as controls, who formed part of a large retrospective cohort study. Rb survivors were interviewed between 1980 and 1983, when they were 30 years old on average. Types of employment and health problems did not differ between survivors and controls, regardless of sight, but the income of blind survivors was considerably less than that of partially sighted survivors. Despite similar marriage rates, fewer survivors than controls reported a pregnancy (RR = 0.45; 95% Cl; 0.24–0.83 for both sexes combined). Parents of children with heritable Rb seemed more likely to have had cancer than parents in families with nonheritable Rb (P = 0.06), and mothers were more likely than fathers to be affected (P = 0.01).This small series suggests that having retinoblastoma may have many long-term consequences, reaching beyond genetic and physical effects to touch family life and income attainment and the health of other family members. Follow-up of more modern cohorts and the use of molecular tools will clarify the long-term consequences of more recent therapies, and patterns of familiar cancer. © 1995 Wiley-Liss, Inc.
  Medical and Pediatric Oncology 07/2006; 24(3):160 - 165.
• Article: Phase I/II study of bisantrene in childhood cancer: A report from the childrens cancer study group

  Nasser Movassaghi MD, William A. Krivit MD, Mark D. Krailo PhD, G. Denman Hammond MD
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  ABSTRACT: A phase I/II study of bisantrene using a 3-week schedule was undertaken in 171 children with refractory leukemias and solid tumors. The doses ranged from 190 to 430 mg/m2. The maximum tolerated dose for children with solid tumors and acute leukemias was 280 mg/m2 and 360 mg/m2 every 3 weeks, respectively. The dose limiting toxicities were hepatic and hematologic. One patient with ALL achieved a complete remission and partial responses were observed in three patients with soft-tissue sarcomas. The data indicate that bisantrene, at the doses and schedule used in this study, has limited antitumor activity in pretreated children with Cancer.
  Medical and Pediatric Oncology 07/2006; 16(5):333 - 336.
• Article: The fifth myron karon memorial lecture; The cure of cancer by chemotherapy ‐ reflections on how it happened

  C. Gordon Zubrod MD
  Medical and Pediatric Oncology 07/2006; 8(2):107 - 114.
• Article: Racial variation in incidence of Wilms' tumor: Relationship to congenital anomalies

  Shira Kramer PhD, Anna T. Meadows, Patricia Jarrett
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  ABSTRACT: This is a study of the occurrence of Wilms' tumor and associated anomalies in all incident cases in the Greater Delaware Valley by race. The average annual incidence of Wilms' tumor in this population of 2 million children is significantly higher among nonwhites than whites. A significantly larger proportion of black cases has a Wilms' tumor-associated condition including aniridia, genito-urinary anomalies, the Beckwith-Wiedemann Syndrome, and hemihypertrophy. For very young patients, there was a greater tendency for blacks to have bilateral tumors or a tumor-associated anomaly, features characteristic of the hereditary form of Wilms' tumor. The excess risk of Wilms' tumor among blacks may be a result of a higher proportion having a hereditary predisposition or more common exposure to agents capable of inducing germinal mutations.
  Medical and Pediatric Oncology 07/2006; 12(6):401 - 405.