Biomedical subjects

C Kalifa

Publications and source records attributed to C Kalifa.

At least 127 records · Page 7Linked to original sources

PubMed1989

Hemorrhagic cystitis following high-dose chemotherapy and bone marrow transplantation in children with malignancies: incidence, clinical course, and outcome.

Two hundred ninety-one courses of high-dose chemotherapy (HDC) with bone marrow transplantation (BMT) in children with malignancies were reviewed in order to assess the incidence, clinical course, outcome, and predisposing factors of hemorrhagic cystitis. Hemorrhagic cystitis occurred in 19 HDC courses (6.5%). Three patients had grade I hematuria linked to thrombopenia, nine had grade II hematuria despite platelet levels greater than 50 x 10(9)/L, and seven had grade III hematuria with clots and bladder obstruction. Severe complications occurred in grade III patients, but no deaths were directly linked to the cystitis. Fourteen patients recovered within two to 120 days of onset. The other patients died before the cystitis resolved, either of a relapse of the malignancy or of infection. Predisposing factors were age (increased incidence in older children), conditioning regimen containing cyclophosphamide, previous vesical irradiation, association with prolonged aplasia, and hepatic complications. The role of busulfan was also probable. No viral agent was found.

Adolescent↗

PubMed1989

[Clinical, anatomo-pathologic aspects and therapeutic results in 63 malignant ORL non-Hodgkin's lymphomas in children].

Sixty-three children with non Hodgkin's lymphoma involving the ENT zone (Waldeyer's ring) were treated between 1975 and 1985 at the Institut Gustave-Roussy. The tumors were localized in the cavum (32 cases), tonsils (16 cases), mandibles (9 cases) whereas 6 patients had more than one of these sites involved. At the time of diagnosis, 16 (25%) had neuro-meningeal involvement. Distribution, according to stages and histology was as follows: 4 stages I, 27 stages II, 12 stages III, 17 stages IV and 3 were unclassifiable. A Burkitt type of lymphoma was diagnosed in 37 (58%), a convoluted lymphoblastic type in 6 (10%) and 20 (32%) fell in a broad category of "other lymphoblastic variety" (32%). With regard to therapy, two consecutive time periods could be identified: from 1975 to 1980 all patients were given the same treatment and neuro-meningeal prophylaxis consisted of irradiation of the skull and intrathecal injections of methotrexate. Since 1981, the therapeutic regimen is designed according to the histo-immunological classification of the tumors and neuro-meningeal prophylaxis is carried out with the use of high dose methotrexate. With this new approach the survival rate has increased from 45 to 80% and the incidence of neuromeningeal relapses has decreased.

Adolescent↗

PubMed1989

[Secondary metastatic neuromeningeal localization of neuroblastoma in children].

In order to evaluate the frequency, clinical and radiological aspects and prognosis of central nervous system metastases in children's neuroblastoma, the 258 children presenting with neuroblastoma, and registered from January 1982 to August 1987, were studied. Among them, 7 patients (2.7%), of which 6 had an initially metastatic neuroblastoma, presented with a secondary neuro-meningeal involvement. Parenchyma involvement (4 cases) occurred after a mean period of time of 21 months and marked the relapses. The disease recurs later on, even when locally controlled by surgical excision and local irradiation. Meningeal involvements (3 cases) occurred after a mean delay of 12.7 months, in patients with full tumoral evolutivity, and were responsible for rapid death. The clinical presentation of these metastases differs from that in adults by the rapidity of setting up of the signs and the frequency of intracranial hypertension. CT scan allows approaching diagnosis in the majority of the cases. These data are compared with those in the literature, where 30 cases were reported: they show a high patients' average age and the worse prognosis.

Brain Neoplasms↗

PubMed1989

Role of parenteral antibiotherapy in gastrointestinal tract flora suppression. A study in children treated with high-dose chemotherapy and autologous bone marrow transplantation.

In order to determine the effect of parenteral antibiotherapy on the fecal flora in patients with profound and prolonged granulocytopenia, we initiated a prospective study of 62 cases of autologous bone marrow transplantation following high-dose chemotherapy. All patients were children from 2 to 18 years old, isolated in a protective environment, receiving a diet low in viable microbial content but no oral non-absorbable prophylactic antibiotics to decontaminate the gastrointestinal tract. Bacteriological analysis of fecal flora was conducted at least once a week before and during parenteral antibiotherapy, administered at the first greater than 38 degrees C febrile episode in these granulocytopenic patients (granulocyte count less than 0.5 X 10(9)/l). The 58 evaluable patients fell into three groups with regard to the systemic antibiotherapy: group A (n = 16): moxalactam + mezlocillin; group B (n = 15): moxalactam + tobramycin; and group C (n = 27): cefotaxime plus gentamicin. Fecal flora suppression was observed in 51/58 cases (88%) (group A: 15/16, group B: 13/15, group C: 23/27). It always occurred within 5 days of initiating parenteral antibiotherapy and persisted in 88% of the 51 patients over the whole period of systemic antibiotherapy. During the latter, fecal recolonization was observed in seven cases (12%), always by Enterobacteriaceae sensitive to the prescribed systemic antibiotherapy, never responsible for septicemia. Since parenteral antibiotherapy alone was able to suppress the gastrointestinal tract flora, the effects of this treatment should be considered in all trials of digestive tract decontamination.

Adolescent↗

PubMed1989

[Malignant histiocytosis in children. Clinical and therapeutic aspects. Apropos of a series of 32 cases].

Thirty-two children with malignant histiocytosis were managed at the Department of Pediatrics of the Gustave-Roussy Institute from January 1975 through December 1987. Clinical presentation included enlarged lymph nodes in all cases, a decline in general health with fever in 74%, skin manifestations in 54%, and visceral involvement in 55%. Twenty-seven patients were treated with the COPAD protocol combining vincristine, cyclophosphamide, adriamycin and prednisone. Twenty-two patients achieved a complete remission, and one a partial remission; there was no remission in four patients. Eight patients had a recurrence and were given a combination of CCNU, vinblastine and bleomycin; seven achieved a second complete remission. Overall survival rate was 72.2% with a median follow up of five years. Survival rate free of disease was 54.5%. Poor prognostic factors included presence of constitutional symptoms upon diagnosis and age under ten years.

Adolescent↗

PubMed1988

[Hepatic complications after high-dose chemotherapy and bone marrow autograft in solid tumors in children].

Two-hundred and thirty-six courses of high-dose chemotherapy with bone marrow transplantation for solid tumors in children were reviewed in order to assess the incidence of hepatic abnormalities and their etiology. Bacterial and fungal hepatitis were excluded from this study. Hepatic complications occurred after 43 courses (20 per cent) in 39 patients. Four patients had hepatic abnormalities after two consecutive courses. Predisposing factors were found to be conditioning regimen including busulfan and previous high dose chemotherapy. Veno-occlusive disease occurred in 11 children and had a fatal outcome in 4. In 9 children, hepatitis was a symptom of diffuse viral infection. In the other 23 courses, hepatitis was isolated but it was difficult to determine whether its etiology was viral (cytomegalovirus, Epstein-Barr virus, adenovirus, HBs, non A non B) or toxic. In these latter forms, the outcome was always good.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1988

Osteosarcoma of the limbs. Report of the EORTC-SIOP 03 trial 20781 investigating the value of adjuvant treatment with chemotherapy and/or prophylactic lung irradiation.

The European Organization for Research on Treatment of Cancer (EORTC) trial 20781, concerning osteosarcoma of the limbs is reported. After definitive treatment of the primary tumor with amputation or irradiation, adjuvant treatment was given, randomized into either 9 months of chemotherapy according to a modified Rosen schedule, or elective bilateral lung irradiation of 20 Gy, or 3 months of chemotherapy followed by lung irradiation. The 4-year disease-free survival and total survival were 24% and 43%, respectively, with no difference between the treatment arms. In the radiotherapy arms the lung metastases were more frequently suitable for surgical treatment. The survival of patients with either tibia localizations or higher age was somewhat better. Local recurrences occurred in 16% of patients, 50% of them with distant metastases. The trial was executed from 1978 to 1983; 205 patients were evaluable and eligible, and three toxic deaths occurred in the chemotherapy arms. Elective lung irradiation provided the same survival as the adjuvant chemotherapy given in that time.

Adolescent↗

PubMed1988

[Experience with protocol T10 in the pediatric service at the Gustave-Roussy Institute].

Between April and September 1986, 60 patients with osteosarcoma have been treated according to the T10 protocol in the Pediatrics Department of the Gustave Roussy Institute in Villejuif, France. Limb sparing could be achieved in 49 patients and amputation was necessary in 11. The necrosis of the primary tumor was total or subtotal in 33 cases and incomplete in the 27 others. With a median follow-up of 28 months, the actuarial survival is 85% at 48 months and the actuarial disease-free survival is 58%; the disease-free survival of "good responders" is 75% and 32% for "bad responders".

Adolescent↗

PubMed1988

Veno-occlusive disease of the liver following high-dose chemotherapy and autologous bone marrow transplantation in children with solid tumors: incidence, clinical course and outcome.

Two hundred and thirty-six consecutive courses of high-dose chemotherapy with autologous bone marrow transplantation in children with solid tumors were reviewed in order to assess the incidence, clinical presentation and outcome of veno-occlusive disease (VOD) of the liver. Patients conditioned with total body irradiation were excluded from this study. Eleven patients (4.6%) met the diagnostic criteria for VOD. The clinical course included sudden weight gain, jaundice, hepatomegaly and ascites. Renal dysfunction and refractoriness to platelet transfusions occurred in the most severe forms. Seven patients recovered within 7-29 days of onset and four patients died, all with renal failure and fluid overload. The time of onset appeared to determine two patterns of outcome: mild forms with early onset (before day 11) and more severe forms with onset after day 17. Analysis of pretransplant factors revealed no significant association with an increased risk of VOD. However, all the patients with severe VOD had received a conditioning regimen containing cyclophosphamide which might be involved in the pathogenesis of VOD.

Adolescent↗

PubMed1988

[Prophylaxis of Gram-positive infections after bone marrow graft. Controlled study of the 6-day administration of vancomycin. Intermediate analysis of 60 patients].

We prospectively evaluated after randomization in 60 consecutive recipients of bone marrow transplantation the efficiency of a short administration of vancomycin (10 mg/kg I.V. q 6 H, day -5 to +1). Thirty-three patients were randomized as controls and 27 were designed to receive vancomycin. Both groups were similar in terms of age, diagnosis, status, allogeneic or autologous graft, in vitro marrow treatment or not. Eighteen patients (30%) experienced bacteremias: 15/18 bacteremias were due to Gram positive organisms, including 11 streptococci. These infections occurred with a similar frequency in both groups, the relatively low incidence of bacteremias in this study needs further evaluation in new patients to insure the prophylactic effects of a course of vancomycin in bone marrow transplant recipients.

Adolescent↗

PubMed1988

[Metastatic neuroblastoma: consolidation treatment with 2 courses of high-dose chemotherapy followed by a bone marrow autograft].

Among 62 children over 1 year of age at diagnosis who were treated for stage IV neuroblastoma, 33 entered remission after conventional therapy. They received high-dose chemotherapy and in vitro purged bone marrow transplantation as consolidation therapy. Fifteen patients received one course and 18 two courses. At present, 16/33 grafted patients are alive in CR with a median follow-up of 28 months. Toxicity of this regimen was tolerable. Under this treatment, actuarial disease free survival is improved compared with that observed under conventional therapy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1987

The radiological appearances of telangiectatic osteosarcoma. A study of 14 cases.

Fourteen telangiectatic osteosarcomas are reported. They are rare, clinically and radiologically aggressive lesions, involving mainly the femurs of young patients, often misdiagnosed as aneurysmal bone cysts. An explanation for a characteristic early radiological appearance consisting of regular parallel striations of the shaft is suggested.

Adolescent↗

PubMed1987

Musculoskeletal tumors: follow-up with MR imaging after treatment with surgery and radiation therapy.

Magnetic resonance (MR) imaging was used as a follow-up technique in 60 patients who underwent surgery and/or radiation therapy for primary malignant musculoskeletal tumors. MR imaging was performed on a 1.5-T imager with T1- and T2-weighted imaging sequences; MR imaging findings were confirmed by means of posttreatment surgery and histologic analysis or follow-up for at least 1 year. If a low-signal-intensity lesion was seen on T2-weighted images in a patient who had undergone radiation therapy or surgery, the patient usually did not have active tumor (sensitivity, 96%). If a high-signal-intensity lesion was seen after a patient had undergone only surgery, the patient had active tumor (six of six such cases). In patients who had undergone only radiation therapy, however, the presence of a high-signal-intensity lesion may indicate either active tumor or radiation-induced inflammatory changes. Thus, in such cases, differential diagnosis of active tumor may be difficult, if not impossible, to make from MR images.

Bone Neoplasms↗

PubMed1987

Repeated high-dose chemotherapy followed by purged autologous bone marrow transplantation as consolidation therapy in metastatic neuroblastoma.

Among 62 children over 1 year of age at diagnosis, who were treated for stage IV neuroblastoma, 33 entered complete remission (CR) or good partial remission (GPR) after conventional therapy and received high-dose chemotherapy (HDC) with in vitro purged autologous bone marrow transplantation (ABMT) as consolidation therapy. The HDC was a combination of carmustine (BCNU), teniposide (VM-26), and melphalan. Thirty-three patients received one course of this regimen, and 18 received two courses. At present, 16 of the 33 grafted patients are alive in continuous CR, with a median follow-up of 28 months. Toxicity of this regimen was tolerable, principally marked by bone marrow depression and gastrointestinal (GI) tract complications. Four complication-related deaths were observed. Relapse post-ABMT occurred most often in the bone marrow. Under this treatment, actuarial disease-free survival is improved compared with that observed under conventional therapy.

Abdominal Neoplasms↗

PubMed1987

Hyponatremia and renal sodium wasting in patients receiving cisplatinum.

Three children with malignant solid tumors developed hyponatremia with renal sodium wasting associated with other signs of tubular dysfunction, such as hypokalemia or hypomagnesemia, a few days after cis-diammine dichloroplatinum (CDDP) administration. The normalization of serum electrolyte disturbances was obtained with increased parenteral intakes in fluids and electrolytes, and renal sodium wasting stopped by itself a few days later.

Adolescent↗

PubMed1986

Treatment of advanced neuroblastoma with high-dose melphalan and autologous bone marrow transplantation.

Fifteen children with advanced neuroblastoma according to Evans' classification (1 with stage III and 14 with stage IV) were treated with high-dose melphalan (HDM) followed by autologous bone marrow transplantation. Before HDM, all patients had been extensively treated with multimodality therapy for a median duration of 9 months. At the time of HDM, seven children were in partial remission (PR) with measurable residual tumor and 8 were in complete remission (CR) or good partial remission (GPR). No reduction in measurable tumor size was observed in any of the PR patients. However, when HDM was used as consolidation therapy (CR and GPR patients) survival appeared encouraging, since five of eight patients are alive with no evidence of disease at (NED) 29+ to 54+ months after HDM. Tolerance of this high-dose chemotherapy was satisfactory; gastrointestinal toxicity appeared to be the most important limiting factor. These results suggest that chemotherapy including high-dose melphalan is promising when used as consolidation therapy in patients who have already attained CR with conventional therapies.

Adolescent↗

PubMed1986

Hepatoblastoma and hepatocarcinoma in children: analysis of a series of 29 cases.

Twenty-nine cases of liver malignancies, 26 hepatoblastomas (HB) and 3 hepatocarcinomas (HC), were treated in a 13-year period. All children were submitted to operation but four had nonresectable tumors, even after chemotherapy. Surgery in the 25 cases consisted of right lobectomy in 14, a left lobectomy in 9, and a tumorectomy in 2; a secondary operation had to be performed in 5 cases, either because of histologic doubt on the cut section of the presumed normal parenchyma, or for local recurrence. Preoperative chemotherapy, instituted on a routine basis since 1982, did appear to facilitate surgery in otherwise inoperable tumors. The benefits of preoperative embolization, done for three children, were minimal. Ten children died, one in the immediate postoperative period, eight others from the disease, and one from a complication of chemotherapy. Follow-up for the 18 surviving children, all recurrence and metastasis-free, with normal alphafetoprotein (AFP) is less than 2 years for four and from 2 to 11 years for 14. One teen-age girl, with a fibrolamellar carcinoma has just recently been reoperated because of recurrence three years later. In spite of the fact that 6 out of 7 children operated without adjunctive treatment are cured, a systematic course of preoperative chemotherapy has been prescribed in the more recent cases. Follow-up for these is yet too short.

Adolescent↗

PubMed1986

High-dose busulfan and cyclophosphamide with autologous bone marrow transplantation support in advanced malignancies in children: a phase II study.

Twenty children with advanced, nonleukemic malignancies entered a phase II study of high-dose busulfan-cyclophosphamide followed by bone marrow transplantation (BMT). All had disease refractory to conventional and/or high-dose chemotherapy (HDC). There were ten neuroblastoma patients, six non-Hodgkin's lymphoma, three Ewing's sarcoma, and one rhabdomyosarcoma. Eight had primarily resistant disease, ten were in second progressive relapse, and two in third progressive relapse. One patient was not evaluable for response. Among the 19 evaluable patients the responses observed were complete response (CR), seven; partial response (PR), three; objective effect, five; and failure, four. However, survival was poor: 15 patients died, two are alive with disease, and three are alive with no evidence of disease (NED) at 8+, 11+, 14+ months post-BMT. Toxicity was high but considered as acceptable, taking into account the terminal state of these patients. Seven treatment-related deaths were observed. This combination therapy proved to be highly effective, with a response rate of 50%, and its value for eradication of residual disease in less advanced patients should be investigated.

Adolescent↗