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Biomedical subjects

G B Humphrey

Publications and source records attributed to G B Humphrey.

At least 37 records · Page 2Linked to original sources
PubMed1985

An analysis of the presence of Fc receptors on bone marrow lymphoblasts in acute lymphoblastic leukemia. A Pediatric Oncology Group study.

The presence or absence of the Fc receptor (FcR) on bone marrow lymphoblasts was evaluated in 279 cases of acute lymphoblastic leukemia (ALL) by member institutions of the Pediatric Oncology Group (POG). The case material was classified as follows: 19 cases of positive (greater than or equal to 20% +), 24 additional cases as intermediate (greater than or equal to 10% but less than 20%), and the remaining 236 cases as negative (less than 10%). Intermediate and positive cases were relatively equally distributed between null cell leukemia and pre-B-cell leukemia, and there were one intermediate and two positive T-cell cases. One of two cases of B-cell leukemia was also positive. There were no distinguishing clinical or laboratory characteristics which distinguished the FcR+ cases, nor was the FcR of prognostic significance within ALL as a group or within immunologically defined phenotypes.

Adult↗
PubMed1985

Comparison of maintenance treatment regimens for first central nervous system relapse in children with acute lymphocytic leukemia. A Pediatric Oncology Group study.

Eighty-seven children with central nervous system (CNS) leukemia were randomized to receive either induction intrathecal chemotherapy (ITC) and cranial irradiation (CRT) plus maintenance ITC, or induction ITC and craniospinal irradiation (CSpRT) with no maintenance ITC. ITC consisted of six weekly injections of methotrexate, hydrocortisone, and arabinosylcytosine. Also, intensification of systemic induction and maintenance chemotherapy was given. CRT + ITC was given as CRT, 2400 rad in 12 fractions followed by ITC maintenance bimonthly for 2 years. Craniospinal irradiation consisted of CRT + 1400 rad in ten fractions to the spine. Randomization was stratified according to whether CNS leukemia occurred at initial diagnosis of acute lymphocytic leukemia (ALL) (Stratum I, 15 patients), during first bone marrow (BM) remission (Stratum II, 49 patients), simultaneous with first BM relapse (Stratum III, 12 patients), or during second BM remission (Stratum IV, 11 patients). The median follow-up for patients who remain at risk is 15 + months. Eight children (seven on CRT + ITC, one on CSpRT) developed presumed therapy related encephalopathy. In Stratum II, 16 of 29 (55%) patients receiving CRT + ITC experienced adverse events: 3 deaths during continuous complete remission (CCR) and 13 relapses (2 CNS, 1 CNS + BM, 1 BM + testes, and 2 testes) as compared with only 5 relapses in 20 (25%) patients on CSpRT (1 CNS, 1 CNS + BM, 1 BM, and 2 testes). The children on both regimens were comparable for sex, race, age at initial ALL diagnosis, time from ALL diagnosis to first episode of CNS leukemia, systemic therapy both before and after CNS relapse, and number of blasts in the spinal fluid at diagnosis of CNS leukemia. The conclusion is that children with isolated CNS leukemia can achieve prolonged survival with aggressive therapy, and that CSpRT is possibly less toxic and more likely than is CRT + ITC to prevent subsequent BM and testicular relapse (P less than 0.02), but not subsequent CNS relapse (P = 0.7). A possible systemic therapy effect of spinal irradiation is postulated to explain the superiority of CSpRT.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Lymphedema secondary to filariasis.

A 1-year-old immunodeficient boy developed brawny edema of the left foot. Lymphoscintigraphy revealed no evidence of left inguinal activity following pedal injection of Tc-99m-Sn phosphate. Over the next two months, the patient developed lymphedema on the right and repeat scintigraphy demonstrated no movement of isotope from the dorsum of either foot. Subsequent studies identified microfilaria in a nocturnal blood smear, which were thought to represent Brugia beaveri acquired by mosquito transmission in Oklahoma.

Brugia↗
PubMed1985

Monoclonal antibody definition of T cell acute leukemia: a Pediatric Oncology Group study.

Leukemic blasts from 774 children with newly diagnosed acute lymphocytic leukemia (ALL) have been phenotyped by microcytotoxicity testing with a panel of monoclonal antibodies and heteroantisera as part of a Pediatric Oncology Group classification study of acute leukemia. One hundred twenty-two cases, or 16% were designated as T cell leukemia based on the reactivity of blast cells with previously well-characterized antisera (PT) against a T lymphocyte-associated antigen. Using this antisera-based definition as a standard, we looked for a monoclonal antibody combination that would be a suitable substitute. An algorithm calling for reactivity with either monoclonal antibody 3A1 or Leu-1 was a 92% sensitive and 97% specific predictor of PT reactivity. Only 27 of 755 cases of leukemia were incorrectly classified using this algorithm. Subsequently, Ficoll-Hypaque-separated bone marrow cells from 118 additional patients with ALL (21 of whom had T cell ALL) were stained by immunofluorescence using a combination of directly fluoresceinated 3A1 and Leu-1. Reactivity of 20% or more of the cells with this antibody combination was a 100% sensitive and 94% specific indicator of T cell ALL defined by PT positivity; with a higher cutoff value for positive values, or the use of supplemental tests, even this small number of false-positives could be eliminated. We conclude that this monoclonal antibody combination is a satisfactory replacement for our heteroantisera definition of T cell ALL.

Antibodies, Monoclonal↗
PubMed1984

Peripheral neuroepithelioma in childhood.

Peripheral neuroepithelioma is a rare and controversial neoplasm that may occur at any age. Fifteen of the 38 previously reported cases have involved children from birth to 17 years of age. The authors observed the course of a 3-month-old girl who presented with an enlarging mass in the left arm and manifested hepatic metastases at the time of diagnosis. The urinary level of vanillylmandelic acid (VMA) was moderately elevated. The primary lesion was excised and metastatic foci showed response to a regimen of vincristine, cyclophosphamide, Adriamycin (doxorubicin), and cisplatin. However, tumor recurred in the brain and liver and the child died 14 months after diagnosis. At autopsy, there was no involvement of adrenal glands or sympathetic ganglia and the liver contained numerous involuted lesions as well as active metastases. It is suggested that this is a unique neoplasm, derived from neural crest but distinct from neuroblastoma, which can be characterized by peripheral origin, a histologic pattern of confluent pseudorosettes, and aggressive clinical behavior.

Adolescent↗
PubMed1984

Pediatric oncology group utilization of immunologic markers in the designation of acute lymphocytic leukemia subgroups: influence on treatment response.

The clinical application of blast cell immunophenotype testing is important in childhood ALL for the following reasons. (1) Knowledge of the immunologic group is important in predicting prognosis. Prognostic grouping may prove to be accomplished best by using a combination of traditional risk factors and immunologic phenotyping. However, definition of traditional risk factors may vary within the immunologic groups of ALL. (2) In assessing the relative effectiveness of different treatment regimens for children with ALL it is important to make comparisons among patients within the same major immunologic groups of ALL. (3) Identification of specific immunologic groups of patients within ALL may help in designing therapy for each group. The POG has already made preliminary attempts in this direction for T-ALL and B-ALL. However, leukemia species-specific therapy is still only a long-range goal. Laboratory research must endeavor to identify additional biologic characteristics peculiar to each major immunologic group of ALL. These characteristics may dictate therapeutic maneuvers in the future.

Antigens, Neoplasm↗
PubMed1983

Leiomyoma presenting as prolonged fever, anemia, and thrombocytosis.

The manifestations of leiomyoma of the large bowel in a 2-year-old boy included prolonged fever, anemia, and thrombocytosis. This parallels the previously reported case in an adult. Awareness of these features may suggest the diagnosis in future patients, and thereby offer opportunities to study the pathogenesis of these abnormalities before surgery.

Anemia↗
PubMed1983

The flag sign of chemotherapy.

A case of horizontal pigmented bands developing within the hair of a patient on intermittent high-dose methotrexate chemotherapy is presented.

Child, Preschool↗
PubMed1983

Neuroblastoma: therapy for infants with good prognosis.

Therapy was designed to achieve a high cure rate and to prevent serious therapeutic side effects for 11 infants younger than one year old with neuroblastoma who had a favorable prognosis (Evans Stages I, II, III, and IV-S). It consisted of surgery alone if the tumor was totally removed (one infant) and of surgery and low doses of cytoxan and vincristine for a period of 1 year if the tumor was incompletely removed (seven infants). In addition, radiation therapy was applied to unresected dumbbell tumors (three infants). All infants are alive without evidence of disease with the exception of one who died in an accident. The follow-up time varies from 2-8 years. The drug combination prevented recurrences in two infants whose tumor was reduced by surgery to less than 10% of the original size. In five infants, chemotherapy reduced the size of large residual tumor masses. Two of these masses were subsequently removed. The tumors of the three other infants recurred while on chemotherapy and were successfully eradicated by surgery or radiation therapy. Two infants were not treated according to this therapeutic plan. Although they had small residual masses after surgery, no chemotherapy was given. They are alive without recurrence of the disease 2 years or more after diagnosis. In summary, cure was achieved in these infants without intensive chemotherapy.

Cyclophosphamide↗
PubMed1982

Properdin factor B and acute lymphocytic leukemia (ALL).

One hundred-sixty-four ALL patients were compared to 545 controls for differences in phenotype and gene frequencies at the Properdin factor B locus. In addition, 90 of the ALL patients were immune phenotyped. A significant association with the Bf F allele and ALL was found, resulting in an estimated relative risk of 3.62. There was no difference in the Bf S phenotype between ALL patients and controls. However, those homozygous for the Bf S allele are at a significantly low risk of 0.30 for developing ALL. ALL patients with a non-B/T cell type were 2.5 times more likely to be Bf SS homozygotes; in contrast, those patients with the pre-B cell type were 2.5 more likely to be Bf FF homozygotes. These data suggest association of the Bf locus with an ALL protection and/or susceptibility gene(s).

Alleles↗
PubMed1982

CNS prophylaxis in acute lymphoblastic leukemia: comparison of two methods a Southwest Oncology Group study.

Children with acute lymphoblastic leukemia were randomized to one of two treatment options for CNS prophylaxis. All patients received intrathecal therapy over a one-year period with methotrexate, hydrocortisone and cytosine arabinoside. One-half of the patients also received 2400 rad cranial radiation over 2 1/2 weeks. There was no significant difference in CNS relapse rate, length of hematologic remission or survival between the two groups. No further CNS relapses have been observed for the last four years. CNS relapse was associated with subsequent disease recurrence in the 67% of patients.

Adolescent↗
PubMed1982

Therapeutic choices made by patients with end-stage cancer.

The Oklahoma Children's Memorial Hospital Oncology Service has developed a new approach for its patients with end-stage cancer. The emphasis is on the patients' acknowledgement of the progression of the disease and the imminence of death, and informed choice between the use of research drugs and no further chemotherapy. Forty-three patients between 6 and 20 years of age participated in a conference of this type. The results demonstrated that they understood that their health was declining. They decided about further therapy autonomously or together with their family. The majority of children who chose supportive care without chemotherapy and lived for a period of time, participated in activities at home as far as their state of health permitted. Severe depression and severe behavioral problems occurred rarely. There was evidence that this open approach enabled patients and family members to communicate openly with each other.

Adolescent↗
PubMed1982

Modified LSA2-L2 treatment in 53 children with E-rosette-positive T-cell leukemia: results and prognostic factors (a Pediatric Oncology Group Study).

In an attempt to improve the poor outlook for children with T-cell leukemia (T-ALL), the Southwest Oncology Group, Pediatric Division, used a modified LSA2-L2 multidrug regimen to treat 53 patients with E-rosette-positive T-ALL. This regimen was chosen because of its demonstrated efficacy in T-cell (mediastinal) non-Hodgkin's lymphoma. Complete remission (CR) rate was 88%. Range of follow-up for those patients remaining in CR is 24-49 mo (median 39 mo). Life table analysis estimates that 40% (SE 8.3%) of all patients who started induction therapy will remain failure-free at 3 yr. For patients achieving CR, 46% (SE 9%) are projected to remain in both marrow and extramedullary CR at 3 yr. Median failure-free duration was 13 mo, but only 1 patient has relapsed beyond 16 mo. Twenty-nine percent of initial relapses were isolated CNS relapses. The following presenting factors did not relate significantly to outcome: hemoglobin, platelet count, uric acid, race, and mediastinal mass. Age greater than 10 yr was a poor prognosis indicator only in the less than 50,000/microliter WBC group. Sex was not a significant factor after adjusting for WBC. WBC was the most important prognostic factor: 19% (SE 8%) of patients with WBC greater than 50,000/microliter are projected to remain failure-free at 3 yr as compared to 67% (SE 11%) of patients with WBC less than 50,000/microliter. Although the overall results are better than those previously reported for pediatric patients with T-ALL, the long-term failure-free rate remains low for patients presenting with greater than 50,000/microliter WBC.

Adolescent↗
PubMed1981

An analysis of clinical and laboratory features of acute lymphocytic leukemias with emphasis on 35 children with pre-B leukemia.

In 35 of 191 patients with acute lymphocytic leukemia (ALL) malignant cells were similar in phenotype to B-lymphocyte precursors. Both these patients' lymphoblasts and normal pre-B-cells contain cytoplasmic immunoglobulin (Ig) mu heavy chains, but have no surface Ig. In patients with pre-B leukemias, lymphoblasts containing cytoplasmic mu chains alone were often accompanied by cells of identical morphology that expressed no Ig and less frequently by lymphoblasts bearing scant amounts of surface mu. This spectrum of cellular Ig expression suggests that "null," pre-B, and intermediate pre-B/B ALLs represent closely related malignancies with complete or partial arrests at different stages of maturation. When pre-B, B, T, and "null" cell categories of ALL were compared for 22 different clinical and laboratory features, including remission rate and short-term remission duration, no statistical differences were observed between the pre-B and "null" groups. These early results suggest that pre-B-cell leukemias represents a relatively good prognostic subclass of ALL, do not require more intensive treatment than that proven to be effective for "null" cell ALL, and should be distinguished from the less common, but more clinically aggressive, B-cell subclass of ALL. Longer follow-up will be required to confirm these preliminary conclusions.

B-Lymphocytes↗