scholarly journals The Application of 99mTc-DTPA Renal Dynamic Imaging to Measuring Renal Function of Children with Acute Lymphoblastic Leukemia after Induction Therapy

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Lidan Wang ◽  
Kailan Chen ◽  
Qiong Xu
Keyword(s):  
Renal Function ◽  
Acute Lymphoblastic Leukemia ◽  
Induction Therapy ◽  
Estimated Glomerular Filtration Rate ◽  
Lymphoblastic Leukemia ◽  
Kidney Injury ◽  
Binary Logistic Regression ◽  
Dynamic Imaging ◽  
High Dose ◽  
Renal Functions

Purpose. The study was aimed at assessing renal functions of children with acute lymphoblastic leukemia (ALL) after induction therapy by 99mTc-DTPA renal dynamic imaging Gates method (GFRGates) and investigating whether renal function after induction therapy will affect the occurrence of high-dose methotrexate- (HDMTX-) induced acute kidney injury (AKI). Methods. Children with newly diagnosed ALL were enrolled. Renal functions before the administration of HDMTX were assessed by estimated glomerular filtration rate (eGFR) and GFRGates, respectively, before the first cycle of HDMTX after induction therapy. The areas under the ROC curve were used to assess covariates’ ability to predict HDMTX-induced AKI. Results. 102 children with ALL were included in the study. A stepwise backward binary logistic regression showed that only standardized GFRGates was an independent risk factor for HDMTX-induced AKI ( p = 0.018 , odds ratio 0.985, 95% CI 0.972-0.997). The area under the ROC of standardized GFRGates was 0.679 ( p = 0.012 , 95% CI 0.554-0.804). Conclusion. Standardized GFRGates showed that the normal renal function of children is not enough to be used as a cutoff point to predict HDMTX-induced AKI in ALL children receiving HDMTX. More attention and supportive care should be given to the children with standardized GFRGates lower than the cutoff value to avoid the HDMTX-induced AKI.

Treatment Outcome and Prognostic Factors for Infants With Acute Lymphoblastic Leukemia Treated on Two Consecutive Trials of the Children's Cancer Group

1999 ◽  
Vol 17 (2) ◽  
pp. 445-445 ◽  
Author(s):  
Gregory H. Reaman ◽  
Richard Sposto ◽  
Martha G. Sensel ◽  
Beverly J. Lange ◽  
James H. Feusner ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Prognostic Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Induction Therapy ◽  
Lymphoblastic Leukemia ◽  
High Dose ◽  
Event Free Survival ◽  
Free Survival ◽  
Cancer Group ◽  
Historical Controls

PURPOSE: Infants represent a very poor risk group for acute lymphoblastic leukemia (ALL). We report treatment outcome for such patients treated with intensive therapy on consecutive Children's Cancer Group (CCG) protocols. PATIENTS AND METHODS: Between 1984 and 1993, infants with newly diagnosed ALL were enrolled onto CCG-107 (n = 99) and CCG-1883 (n = 135) protocols. Postconsolidation therapy was more intensive on CCG-1883. On both studies, prophylactic treatment of the CNS included both high-dose systemic chemotherapy and intrathecal therapy, in contrast to whole-brain radiotherapy, which was used in earlier studies. RESULTS: Most patients (> 95%) achieved remission with induction therapy. The most frequent event was a marrow relapse (46 patients on CCG-107 and 66 patients on CCG-1883). Four-year event-free survival was 33% (SE = 4.7%) on CCG-107 and 39% (SE = 4.2%) on CCG-1883. Both studies represent an improvement compared with a 22% (SE = 5.1%) event-free survival for historical controls. Four-year cumulative probabilities of any marrow relapse or an isolated CNS relapse were, respectively, 49% (SE = 5%) and 9% (SE = 3%) on CCG-107 and 50% (SE = 5%) and 3% (SE = 2%) on CCG-1883, compared with 63% (SE = 6%) and 5% (SE = 3%) for the historical controls. Independent adverse prognostic factors were age less than 3 months, WBC count of more than 50,000/μL, CD10 negativity, slow response to induction therapy, and presence of the translocation t(4;11). CONCLUSION: Outcome for infants on CCG-107 and CCG-1883 improved, compared with historical controls. Marrow relapse remains the primary mode of failure. Isolated CNS relapse rates are low, indicating that intrathecal chemotherapy combined with very-high-dose systemic therapy provides adequate protection of the CNS. The overall unsatisfactory outcome observed for the infant ALL population warrants the future use of novel alternative therapies.

A Comparison of Two Induction Regimens for Older Patients with Acute Lymphoblastic Leukemia: Daunorubicin, Vincristine and Prednisone (DVP) is Worth Considering

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3252-3252
Author(s):  
Daniel Landsburg ◽  
David Porter ◽  
Edward Stadtmauer ◽  
Alison Loren ◽  
Donald Tsai ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Maintenance Therapy ◽  
Induction Therapy ◽  
Older Patients ◽  
Lymphoblastic Leukemia ◽  
Complete Response ◽  
High Dose ◽  
Treatment Groups ◽  
Social Security Death Index

Abstract Abstract 3252 Background: The prognosis for older patients with newly-diagnosed acute lymphoblastic leukemia (ALL) is generally poor, although a limited number of studies suggest that these patients can experience favorable outcomes when treated with standard intensive chemotherapy. However, a comparative analysis of curative regimens has not been performed to date. Here, we describe outcomes in patients diagnosed with ALL at age ≥60 who received induction at our institution with either hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with high-dose methotrexate and cytarabine (hyperCVAD) or daunorubicin, vincristine and prednisone (DVP). Methods: Of the 44 patients diagnosed with ALL at age ≥60 who were treated at the University of Pennsylvania between July 2003 and June 2009, 38 received either hyperCVAD (n=24) or DVP (n=14). Induction regimens were chosen at the discretion of the treating physician. Patients in the hyperCVAD group received a median of 6 (range 1–8) cycles. Patients in the DVP group received a full course of induction therapy following the regimen used in the ECOG 2993/UKALL XII protocol with a majority receiving second induction, intensification and consolidation therapy. L-asparaginase was omitted from DVP therapy for all but 2 patients. Assessment for response or relapse was performed primarily via bone marrow biopsy as clinically indicated. If lost to follow-up, patients with previously documented remission were considered to remain in remission through the time of their last normal complete blood count. All deaths were confirmed through the Social Security Death Index. Categorical data was analyzed via the Fisher's exact test and survival times were calculated via Kaplan-Meier plots. Results: Table 1 reports baseline characteristics at diagnosis for patients in the hyperCVAD and DVP groups. Tables 2 and 3 report the rates of complete response (CR) and relapse as well as median progression free survival (PFS) and median overall survival (OS) for the two treatment groups. The median length of follow-up was 12.5 months for the hyperCVAD group (range 3–70) and 24 months for the DVP group (range 4–136). Five-year survival was 4% for hyperCVAD patients and 36% for DVP patients (p=0.019). No deaths occurred within the initial 2 months of treatment in either group. Maintenance chemotherapy was received by 50% of hyperCVAD patients and 70% of DVP patients. Of the Ph(+) patients in who received hyperCVAD, 75% received a tyrosine kinase inhibitor (TKI) with induction therapy and 50% with maintenance therapy. Of the Ph(+) patients in who received DVP, 29% received a TKI with induction therapy and 83% with maintenance therapy. All Ph(+) patients who experienced OS greater than the median OS for Ph(+) patients within their respective treatment groups received a TKI. These results did not achieve statistical significance unless otherwise noted. Conclusions: Older patients diagnosed with ALL can enjoy prolonged survival when treated with intensive induction regimens. While this has been previously described in patients receiving hyperCVAD, our analysis indicates that patients diagnosed with ALL at age ≥60 treated with DVP may experience longer OS compared to those treated with hyperCVAD despite an apparent lower rate of complete response and similar rate of relapse. Additionally, Ph(+) patients within this population may experience similar or better outcomes than Ph(-) patients when treated with either regimen, possibly related to the use of TKIs. Prospective trials are warranted to more rigorously evaluate these induction therapies in the older ALL population. Disclosures: No relevant conflicts of interest to declare.

Receipt of Maintenance Therapy Is Most Predictive of Survival in Older Acute Lymphoblastic Leukemia Patients Treated with Intensive Induction Chemotherapy Regimens.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2600-2600
Author(s):  
Daniel J. Landsburg ◽  
Edward A. Stadtmauer ◽  
Alison W. Loren ◽  
Steven C. Goldstein ◽  
Noelle V. Frey ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Lymphoblastic Leukemia ◽  
Maintenance Therapy ◽  
Induction Therapy ◽  
Lymphoblastic Leukemia ◽  
Intensive Therapy ◽  
Small Sample ◽  
Hazard Ratio ◽  
High Dose ◽  
Cox Regression Analysis

Abstract Abstract 2600 Background: Older patients diagnosed with acute lymphoblastic leukemia (ALL) receiving intensive induction therapy often suffer from poor outcomes due to therapy-related toxicity and high rates of relapse. We previously reported that patients age ≥60 diagnosed with ALL and treated at our institution with either hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with high-dose methotrexate and cytarabine (hyperCVAD) or daunorubicin, vincristine and prednisone (DVP) induction therapies achieved comparable rates of survival. Now with longer follow-up and further analysis, we describe additional outcomes and factors predictive of survival in this patient population. Methods: Thirty-seven patients diagnosed with ALL at age ≥60 and treated at the University of Pennsylvania between July 2003 and June 2011 who received induction therapy with either hyperCVAD (≥1 A+B cycle) or DVP (phase I+II) were analyzed. HyperCVAD was administered as first described at the MD Anderson Cancer Center and DVP per the ECOG 2993/UKALL XII protocol. Therapy adjustments and bone marrow biopsy to confirm remission were performed at the discretion of the treating physician. Almost all Philadelphia chromosome (Ph) positive patients received a tyrosine kinase inhibitor. Event-free survival (EFS) was defined as the time from diagnosis to either relapse or death from any other cause. Results: Table 1 describes baseline characteristics. Table 2 describes outcomes. If achieved, morphologic remission was recognized upon the first bone marrow assessment performed while on therapy, which occurred after a median of 4 (2 A+B) cycles of hyperCVAD and by completion of phase II induction of DVP. EFS and overall survival (OS) trended in favor of DVP. HyperCVAD patients were more likely to complete intensive therapy but less likely to receive maintenance therapy, and more likely to relapse with the majority of relapses occurring off active treatment. Primary reasons for not starting or stopping maintenance therapy were infections and cytopenias. Relapsed disease was the most frequent cause of death. Table 3 describes univariate Cox regression analysis. Receipt of maintenance therapy demonstrated the strongest association with survival (p=0.0001, hazard ratio 0.06 for EFS; p=0.0002, hazard ratio 0.05 for OS). Valid multivariate analysis could not be performed due to small sample size. Conclusions: In older ALL patients treated with aggressive induction therapies and achieving remission, receipt of maintenance therapy appears to be most predictive of EFS and OS. Outcomes in the DVP and hyperCVAD groups were similar although a trend towards prolonged survival in the DVP group was seen, which may be explained by a lower rate of relapse due to a higher likelihood of remaining on therapy over time. Our findings suggest that these patients may benefit from attenuated courses of intensive initial therapy in order to avoid developing toxicities that may prohibit tolerance of prolonged maintenance therapy. Disclosures: No relevant conflicts of interest to declare.

Erythropoietin and Protection of Renal Function in Cardiac Surgery (the EPRICS Trial)

2014 ◽  
Vol 121 (3) ◽  
pp. 582-590 ◽  
Author(s):  
Alain Dardashti ◽  
Per Ederoth ◽  
Lars Algotsson ◽  
Björn Brondén ◽  
Edgars Grins ◽  
...  
Keyword(s):  
Renal Function ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Cystatin C ◽  
Estimated Glomerular Filtration Rate ◽  
Artery Bypass ◽  
Kidney Injury ◽  
High Dose ◽  
Single High Dose ◽  
The Third

Abstract Background: To date, there are no known methods for preventing acute kidney injury after cardiac surgery. Increasing evidence suggests that erythropoietin has renal antiapoptotic and tissue protective effects. However, recent human studies have shown conflicting results. The authors aimed to study the effect of a single high-dose erythropoietin preoperatively on renal function after coronary artery bypass grafting in patients with preoperative impaired renal function. Methods: This single-center, randomized, double-blind, placebo-controlled study included 75 patients scheduled for coronary artery bypass grafting with preexisting renal impairment estimated glomerular filtration rate based on p-cystatin C (<60 and >15 ml/min). The patients either received a single high-dose erythropoietin (400 IU/kg) or placebo preoperatively. The primary endpoint was renal protection evaluated by p-cystatin C at the third postoperative day compared to the preoperative values. Incidence of acute kidney injury and other renal biomarker changes were among secondary endpoints. Results: There was no statistically significant difference on the third postoperative day for relative p-cystatin C level changes from baseline between the groups, 131 ± 31% (mean ± SD) for the study group and 125 ± 24% for the control group (P = 0.31; 95% CI, −0.6 to 20% for the difference). There were no statistically significant differences in other renal biomarkers or measures between the groups (p-neutrophil gelatinase–associated lipocalin, p-creatinine, p-urea, and estimated glomerular filtration rate). There were no other differences in outcome variables between the groups. Conclusion: Intravenous administration of a single high-dose (400 IU/kg) erythropoietin did not have a renal protective effect on patients with reduced kidney function undergoing coronary artery bypass surgery.

Levels of L-asparagine in CSF after intramuscular administration of asparaginase from Erwinia in children with acute lymphoblastic leukemia.

1995 ◽  
Vol 13 (2) ◽  
pp. 339-344 ◽  
Author(s):  
S P Dibenedetto ◽  
A Di Cataldo ◽  
R Ragusa ◽  
C Meli ◽  
L Lo Nigro
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Induction Therapy ◽  
Standard Dose ◽  
Lymphoblastic Leukemia ◽  
Intramuscular Administration ◽  
High Dose ◽  
Antileukemic Effect ◽  
To Receive

PURPOSE As part of a study on the pharmacokinetics associated with the administration of asparaginase (ASNase) from Erwinia to the CNS, we determined the levels of asparagine in the CSF of children with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS Twenty children received eight standard doses of intramuscular ASNase (10,000 IU/m2) every 3 days as part of induction therapy. In the postremission phase of therapy, the children were randomized to receive either 20 courses of high-dose intramuscular ASNase (25,000 IU/m2) weekly (n = 8) or four courses of standard-dose intramuscular ASNase (10,000 IU/m2) every 3 days (n = 12). RESULTS All patients had detectable levels of L-asparagine in the CSF at the time of diagnosis. The levels of L-asparagine in CSF were undetectable in 15 of 20 (75%) and in seven of 19 (36.8%) children 3 and 5 days, respectively, after administration of standard-dose ASNase. After administration of high-dose ASNase, the levels of L-asparagine in the CSF were undetectable in five (62.5%) and two (25%) of eight children after 3 and 5 days, respectively. CONCLUSION In this study 60% to 70% and 25% to 35% of children had complete depletion of L-asparagine from the CSF after 3 and 5 days, respectively, after administration of both schedules of ASNase from Erwinia. In the remaining patients, administration of ASNase may have resulted in a suboptimal antileukemic effect at the CNS level.

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