scholarly journals A Comparative Study of Two Regimens of Combination Chemotherapy in Acute Leukemia

Blood ◽  
1958 ◽  
Vol 13 (12) ◽  
pp. 1126-1148 ◽  
Author(s):  
EMIL FREI ◽  
JAMES F. HOLLAND ◽  
MARVIN A. SCHNEIDERMAN ◽  
DONALD PINKEL ◽  
GEORGE SELKIRK ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Survival Time ◽  
Median Survival ◽  
Combination Chemotherapy ◽  
Drug Toxicity ◽  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Acute Myelocytic Leukemia ◽  
Myelocytic Leukemia ◽  
Remission Status

Abstract A comparative clinical trial of two regimens of combination chemotherapy has been accomplished in acute leukemia by four separate medical and pediatric services. Sixty-five patients were allocated at random to one of two treatment programs. Daily administration of methotrexate with daily 6-mercaptopurine has been compared to methotrexate every third day in the same total dose with daily 6-mercaptopurine. No difference in frequency of remission, extent of remission or toxicity was observed between the two groups. Among those patients who attained remission status, however, duration of remission (P = .05-.10) and of survival (P = <.05) was longer for the continuous group. All remissions in children occurred in acute lymphocytic leukemia, whereas all remission in adults were observed in acute myelocytic leukemia. The duration of remissions was somewhat shorter for children with acute lymphocytic leukemia than for adults with acute myelocytic leukemia. The frequency of remission, either partial or complete, was higher in children, however (36 per cent), than in adults (19 per cent), although the confidence limits for each figure overlap. The duration of acute leukemia in previously untreated patients did not influence response to therapy from the two antimetabolite regimens in this study. In patients who had had prior antimetabolite therapy, however, complete remissions were attained less often than in previously untreated patients. The toxic manifestations encountered during the administration of these antimetabolites are described. Seventeen deaths occurred during this study, of which 8 occurred in the first 10 days, presumably from leukemia and not drug toxicity. Five patients died with hypoplastic marrows ascribed to drug toxicity. The toxic manifestations were qualitatively and proportionately the same in patients who attained remission status, and in those patients who failed to remit, but who lived long enough to recognize the onset of remission if it were going to occur. No indication was obtained, therefore, that patients who attained remission were subjected to a greater toxic hazard, in order to achieve the therapeutic benefits observed, than those who did not remit. The median survival of patients who achieved remission was longer (p <.05) than for patients who did not remit. Since the survival time of remitters from relapse to death was almost identical with the survival time of nonremitters from onset of treatment to death, this difference can be accounted for by the time spent in remission and getting to remission. The median survival time from symptomatic onset for all children in this study was 12 months, and for adults, 7 months. The median in children is similar to that reported from other clinics. This is evidence that a comparative therapeutic trial in acute leukemia can be accomplished without recognizable compromise of patient welfare.

scholarly journals Association between thrombocyte and neutrophyl count with cutaneous manifestations in children with acute lymphocytic leukemia and acute myelocytic leukemia

2019 ◽  
Vol 7 (2) ◽  
pp. 551
Author(s):  
Eva Hariani ◽  
Sri Wahyuni Purnama ◽  
Remenda Siregar
Keyword(s):  
Acute Leukemia ◽  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
P Value ◽  
Acute Myelocytic Leukemia ◽  
Cross Sectional ◽  
Hematopoietic Stem ◽  
Cutaneous Manifestations ◽  
Peripheral Tissues ◽  
Myelocytic Leukemia

Background: Acute leukemia is a hematopoietic stem cell malignant disease, with abnormal proliferation of leukemic and immature cells that suppress the production of normal blood cell and extensively invade peripheral tissues organs including skin. Homeostatic abnormalities that occur in leukemia e.g. thrombocytopenia and neutropenia. Various cutaneous manifestations can be observed in leukemia but the etiology is usually unknown, because many factors are responsible for this cutaneous manifestation. The aim of the present study was to determine association between thrombocyte and neutrophyl count with cutaneous manifestations in children with Acute Lymphocytic Leukemia (ALL) and Acute Myelocytic Leukemia (AML).Methods: This is an observational analytical cross-sectional study involving 51 children with acute leukemia (ALL and AML) were hospitalized in H. Adam Malik General Hospital Medan during April – September 2018. Interview, dermatology examination and recording thrombocyte and neutrophil count were performed to the subjects. Differences between thrombocyte and neutrophyl count with cutaneous manifestations were analyzed using Mann Whitney test. Association between thrombocyte and neutrophyl count with cutaneous manifestations were analyzed using Kolmogorov Smirnov test.Results: Children with Acute Leukemia in this study most of them were girls (51.0%), age between 0 - 5years old (39.2%). There were no significant differences between thrombocyte and neutrophyl count with cutaneous manifestations in children with acute leukemia (p value 0.692 and 0.814). There was no significant association between thrombocyte and neutrophyl count with cutaneous manifestations in children with acute leukemia (p value 0.490 and 0.803).Conclusions: There is no significant association between thrombocyte and neutrophyl count with cutaneous manifestations in children with acute leukemia.

scholarly journals The Significance of Bone Marrow Lymphocytosis of Acute Leukemia Patients in Remission

Blood ◽  
1968 ◽  
Vol 32 (5) ◽  
pp. 767-773 ◽  
Author(s):  
ROLAND T. SKEEL ◽  
EDWARD S. HENDERSON ◽  
JOHN M. BENNETT
Keyword(s):  
Bone Marrow ◽  
Complete Remission ◽  
Acute Leukemia ◽  
Median Survival ◽  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
The Past ◽  
Remission Status ◽  
Remission Duration ◽  
Subsequent Relapse

Abstract Bone marrow lymphocytosis (BML) 20 per cent or greater occurring during remission of acute leukemia has been looked upon in the past as an unfavorable sign that may presage early subsequent relapse. Seventy-four patients with acute lymphocytic leukemia were studied to evaluate the significance of BML in remission. It was found that 14 patients with less than 20 per cent bone marrow lymphocytes at any time in remission had a median remission duration of 3 months and a median survival of 21 months, while 60 patients with 20 per cent or more bone marrow lymphocytes at any time in remission had a median remission duration of 14 months and a median survival time of 34 months. Patients with AGL and lymphocytosis had remissions and survivals not significantly longer than those without lymphocytosis It is concluded that there is no justification for excluding a patient from complete remission status because of bone marrow lymphocytosis.

scholarly journals Erythroid Homograft Following Leukocyte Transfusion in a Patient with Acute Leukemia

Blood ◽  
1965 ◽  
Vol 26 (5) ◽  
pp. 587-596 ◽  
Author(s):  
ROBERT H. LEVIN ◽  
JACQUELINE WHANG ◽  
PAUL P. CARBONE ◽  
EMIL J. FREIREICH
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Blood Group ◽  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Chronic Myelocytic Leukemia ◽  
Myelocytic Leukemia ◽  
Factors Influencing ◽  
Female Donor ◽  
Treatment Of Infection

Abstract A patient with acute lymphocytic leukemia developed a functioning erythroid homograft after transfusion of leukocytes from donors with chronic myelocytic leukemia. Two donor populations were observed cytogenetically, by examination of the recipient’s marrow for sex and Philadelphia chromosomes. The cells from a female donor of different blood group eventually repopulated the entire bone marrow and were exclusively responsible for the function of the homograft. Although the donor was anemic and required periodic transfusions, her transplanted cells caused normal erythropoiesis in the recipient for a prolonged period. During this time the recipient enjoyed remission of acute leukemia but expired as a result of overwhelming infection. It is proposed that multiple transfusions of leukocytes is a useful technic for treatment of infection, for increasing knowledge of factors influencing hematopoiesis, and for studying approaches to effective immunotherapy of leukemia.

scholarly journals Factors That Influence the Appearance of Central Nervous System Leukemia

Blood ◽  
1973 ◽  
Vol 42 (6) ◽  
pp. 935-938 ◽  
Author(s):  
Santiago Pavlovsky ◽  
Mariana Eppinger-Helft ◽  
Federico Sackmann Muriel
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Acute Lymphocytic Leukemia ◽  
Treatment Protocol ◽  
Lymphocytic Leukemia ◽  
Acute Myelocytic Leukemia ◽  
Cns Involvement ◽  
Lymphoid Leukemia ◽  
Myelocytic Leukemia ◽  
Wbc Count

Abstract At present, central nervous system (CNS) leukemia is one of the principal causes for termination of complete remission in acute lymphocytic leukemia (ALL). The factors which influence the increase of CNS infiltration have been studied comparing different parameters (age, initial peripheral WBC count, type of leukemia, and presence or absence of initial organomegaly) to determine the leukemia population with highest risk of developing this syndrome. A total of 127 cases of acute lymphoid leukemia (ALL) (98 children and 29 adults) and 101 acute myelocytic leukemia (AML) (41 children and 60 adults), on the same treatment protocol from 1967 to 1970, were included in this study. The median survival and the rate of incidence of symptomatic CNS leukemia was 18 mo and 32% in ALL and 4 mo and 7% in AML. The incidence of CNS leukemia per month of survival was similar in both groups: 4 mo, 3% in AML and 4% in ALL, at 8 mo, 13% in both ALL and AML. The incidence of CNS leukemia was higher in children with ALL than in adults: 41% in children and 19% in adults at 20-mo survival. Organomegaly (spleen, liver and/or lymph nodes) as an early manifestation increased the risk of CNS involvement. The CNS infiltration was significantly greater in patients with high initial peripheral WBC count. The incidence of meningeal leukemia did not differ in ALL and AML. In conclusion, CNS leukemia infiltration was more frequent in children with initial organomegaly and high WBC count at the time of diagnosis.

scholarly journals Variation in Survival Among Patients With Acute Lymphocytic Leukemia

Blood ◽  
1971 ◽  
Vol 37 (1) ◽  
pp. 59-72 ◽  
Author(s):  
C. ZIPPIN ◽  
S. J. CUTLER ◽  
W. J. REEVES ◽  
D. LUM
Keyword(s):  
Prognostic Factors ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Age Group ◽  
Disease Characteristics ◽  
Survival Pattern ◽  
Selection Of

Abstract Survival of 873 acute lymphocytic leukemia patients has been reviewed in relation to a number of patient and disease characteristics at first hospital admission. Study of survival by individual years of age at diagnosis led to the selection of five age intervals: 1-3, 4-10, 11-19, 20-49, and 50 years and over. For each sex the survival after age 10 was considerably poorer than for the younger ages. The best survival for any age-sex group was that for girls 4-10, who had a median survival time of 14.0 months compared with an overall median survival time of 7.8 months for patients of both sexes over 1 year of age. We attempted to determine whether a favorable distribution of other factors related to survival might work to the advantage of girls in the 4-10 year age group. However, in studying factors such as symptoms and hematological characteristics it was the pattern, rather than the exception, to find within most levels of a characteristic under study, that girls 4-10 had the best survival. It would be interesting and potentially valuable to see whether the findings in this study are confirmed in other series. If a specific age-sex group tends to maintain a superior survival pattern, additional exploration of prognostic factors may uncover important leads concerning the biology of the disease.

Higher Incidence of Relapse with Peripheral Blood Rather Than Marrow as a Source of Stem Cells in Adults with Acute Myelocytic Leukemia, but Not in Adults with Acute Lymphocytic Leukemia Autografted during the First Remission

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3311-3311
Author(s):  
Norbert C Gorin ◽  
Myriam Labopin ◽  
Emmanuelle Polge ◽  
Benedicte Samey ◽  
Vanderson Rocha
Keyword(s):  
Peripheral Blood ◽  
Acute Lymphocytic Leukemia ◽  
White Cell Count ◽  
Lymphocytic Leukemia ◽  
Acute Myelocytic Leukemia ◽  
Myelocytic Leukemia ◽  
Variate Analysis ◽  
First Remission ◽  
Total Body ◽  
Related Mortality

Abstract The cell source for autologous stem cell transplantation has shifted since 1994 from bone marrow (BM) to peripheral blood (PB). However, no study has compared outcomes. We analyzed 2165 adults with acute myelocytic leukemia (AML) and 1545 adults with acute lymphocytic leukemia (ALL) in first complete remission (CR1) who received autografts (AML: 1607 PB and 558 BM, ALL: 1126 PB and 416 BM) from 1994 to 2006. AML: Relative to the time of CR1, PB transplants were performed earlier than BM transplants. Since a poorer outcome was associated with a shorter interval from CR1 to PB transplantation, patients were divided into three groups: BM, early PB (≤ 80 days after CR1) and late PB transplants. BM recipients were younger, and more received total body irradiation. In multivariate analysis, transplant-related mortality was not different among groups, but relapse incidence (RI) was higher for early PB (p = .0006) and late PB (p = .01) compared to BM (56 ± 3%,.46 ± 2%, 39 ± 2% respectively). Earlier PB (p= .02) and later PB transplants (p= .06) were associated with a lower three year LFS rate than marrow (36± 3%, 46 ± 2%, 52± 2% respectively). ALL:: In multi variate analysis the only poor prognostic factors were a high white cell count at diagnosis and cytogenetics (presence of the Phi/bcr-abl). The RI and LFS at 2 years were identical in patients receiving BM and PB ( 45 ± 3% vs 47 ± 2% and 47 ± 3% vs 46 ± 2% respectively) In conclusion, in AML patients autografted in CR1 but not in ALL, risk of relapse was lower with BM than with PB, independent of the CR1 to transplantation interval.

scholarly journals Arabinosyl Cytosine: A Useful Agent in the Treatment of Acute Leukemia in Adults

Blood ◽  
1968 ◽  
Vol 32 (4) ◽  
pp. 507-523 ◽  
Author(s):  
ROSE RUTH ELLISON ◽  
JAMES F. HOLLAND ◽  
MARISE WEIL ◽  
CLAUDE JACQUILLAT ◽  
MICHEL BOIRON ◽  
...  
Keyword(s):  
Remission Rate ◽  
Hemoglobin Level ◽  
Lymphocytic Leukemia ◽  
Acute Myelocytic Leukemia ◽  
Pyrimidine Nucleoside ◽  
Myelocytic Leukemia ◽  
Daily Dose ◽  
Significant Superiority ◽  
Infusion Duration ◽  
Arabinosyl Cytosine

Abstract Arabinosyl cytosine (ara-C), a synthetic pyrimidine nucleoside related to the normal metabolites cytidine and deoxycytidine, has been found capable of producing marrow remission at tolerable doses in acute myelocytic and acute lymphocytic leukemia in adults. There were 16 per cent remissions complete in all aspects, 3 per cent complete except for hemoglobin level, and 6 per cent partial remissions among 180 adults with acute myelocytic leukemia treated with any one of 8 variants of infusion duration or daily dose of ara-C. Twenty-four per cent of 37 adults with acute lymphocytic or unclassified leukemia had complete or partial remissions. The comparison of 1, 4, 12 and 24 hours infusion of ara-C (to total dose tolerated) does not show significant superiority for any one group. The complete remission rate with 1 or 12 hour infusions, however, is 25 per cent (superior to that obtained with 6-mercaptopurine) and the recommended schedule of treatment for ara-C based on these data is, therefore, daily infusions of 100 or 50 mg./m.2 in one hour for approximately 3 to 6 weeks followed by maintenance therapy of once weekly subcutaneous injection of 30 mg./m.2 of ara-C. Platelet transfusions should be available when ara-C is used.

scholarly journals Acute Leukemia With C-G Chromosome Translocation

Blood ◽  
1973 ◽  
Vol 41 (2) ◽  
pp. 259-263 ◽  
Author(s):  
Elliott Hinkes ◽  
Barbara F. Crandall ◽  
Felice Weber ◽  
Charles G. Craddock
Keyword(s):  
Acute Leukemia ◽  
Acute Lymphocytic Leukemia ◽  
Chromosome Translocation ◽  
Lymphocytic Leukemia ◽  
The Family

Abstract The occurrence of acute lymphocytic leukemia in a young man with a C-G translocation is described. Two members of his family also show C-G translocations but have not as yet developed leukemia. A third member of the family, on whom no chromosomal information was available, died of acute lymphocytic leukemia.

scholarly journals Central Nervous System Therapy and Combination Chemotherapy of Childhood Lymphocytic Leukemia

Blood ◽  
1971 ◽  
Vol 37 (3) ◽  
pp. 272-281 ◽  
Author(s):  
RHOMES J. A. AUR ◽  
JOSEPH SIMONE ◽  
H. OMAR HUSTU ◽  
THOMAS WALTERS ◽  
LUIS BORELLA ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Complete Remission ◽  
Combination Chemotherapy ◽  
Acute Lymphocytic Leukemia ◽  
Viral Infections ◽  
Combined Therapy ◽  
Lymphocytic Leukemia ◽  
Intrathecal Methotrexate ◽  
Central Nervous System Relapse

Abstract In earlier combination chemotherapy regimens for childhood acute lymphocytic leukemia, nervous system leukemia terminated complete remission in over half the patients in a median time of 11 months. In the present study, cranial radiation (2400 R, 60Co) and intrathecal methotrexate given early in remission were added to combination chemotherapy in an attempt to prevent or delay central nervous system relapse and termination of complete remission. Of 35 consecutive children with previously untreated acute lymphocytic leukemia, 20 of 30 who attained remission and received all initial phases of therapy have been in continuous complete remission for 23 to 30 months. Complete remission was terminated by nervous system relapse in three patients and by hematological relapse in five. Two patients died in complete remission of viral infections and others experienced reversible drug toxicity. We conclude that this combined therapy reduces the incidence of nervous system relapse in the first 2 years and prolongs complete remission.

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