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Biomedical subjects

G Rivera

Publications and source records attributed to G Rivera.

At least 73 records · Page 4Linked to original sources
PubMed1980

VM-26 and cytosine arabinoside combination chemotherapy for initial induction failures in childhood lymphocytic leukemia.

Combination chemotherapy with VM-26 and ara-C was given to 14 children with acute lymphocytic leukemia who had not responded to initial treatment with prednisone, vincristine, daunomycin, and asparaginase. Nine of these patients had also received ara-C. At diagnosis, five children were classified as having standard prognostic features and nine as being at high risk for treatment failure. The drug combination was administered by vein twice a week for four weeks at dosages of 165 mg/m2 for VM-26 and 300 mg/m2 for araC. Nine complete remissions, five in patients with high-risk leukemia, were induced with acceptable toxicity; all 9 subsequently were given continuation therapy with oral mercaptopurine and methotrexate. Four of the 9 patients have relapsed at 2--21 months. All treatment was stopped in 2 patients after 30 months of complete remission. Combinations of VM-26 and ara-C represent an alternative remission induction treatment for patients who fail to attain initial remission with agents of established effectiveness. These agents may especially benefit patients with prognostic features indicating a high risk of treatment failure.

Adolescent↗
PubMed1980

Combined VM-26 and cytosine arabinoside in treatment of refractory childhood lymphocytic leukemia.

On the basis of previous findings at this institution, VM-26 and Cytosine Arabinoside (ara-C) were used in combination to treat 33 children with refractory acute lymphocytic leukemia (ALL). Chemotherapy was given by vein twice a week for four weeks at dosage of 300 mg/m2 for ara-C and 50, 75, 110, 165, or 200 mg/m2 for VM-26. Ten marrow remissions (nine complete and one partial) were induced, with hypotension (2/33) and bone marrow hypoplasia (20/33) the most significant side effects observed. Therapeutic responses were obtained with each dosage of VM-26 except 75 mg/m2; myelosuppression developed at all dosages, being most prolonged at 200 mg/m2. Ten of the 23 non-responders did not complete their planned courses of therapy. The significance of this information is that combinations of VM-26 and ara-C were effective in patients who were either in late stages of their leukemia or had never achieved an initial remission. All had been previously treated with prednisone, vincristine, daunomycin and L-asparaginase. In addition, seven of the 10 responders had previously received ara-C in other drug combinations. The use of VM-26 and ara-C in combination may be warranted for newly diagnosed patients who are at high risk for treatment failure with first-line drugs.

Adolescent↗
PubMed1980

Successful management of bacterial endocarditis of the mitral valve due to Staphylococcus epidermidis in an immunosuppressed host.

We report the successful management of bacterial endocarditis of the mitral valve, caused by Staphylococcus epidermidis, in a 34-month-old boy with acute lymphocytic leukemia who had been receiving immunosuppressive therapy. M-mode echocardiography provided early detection of valvular vegetations and documented the evolution of valvular involvement during the course of the illness.

Anti-Bacterial Agents↗
PubMed1980

Phase I clinical and pharmacokinetic study of 4'-(9-acridinylamino)-methanesulfon-m-anisidide in children with cancer.

Forty-one pediatric patients with advanced cancer (24 with acute leukemia and 17 with diverse solid tumors) received 74 courses of therapy with a new chemotherapeutic agent, 4'-(9-acridinylamino)methanesulfon-m-anisidide (AMSA: NSC 249992). Treatments were given by slow i.v. injection daily for five days every two to three weeks. In patients with leukemia: (a) dosages were escalated from 1.3 to 150 mg/sq m/day; (b) toxicity in the form of stomatitis, vomiting, and phlebitis occurred at dosage levels of 125 to 150 mg/sq m/day; and (c) oncolytic effects were observed in 13 of 24 patients. In patients with solid tumors: (a) dosages were escalated from 5 to 50 mg/sq m/day; (b) toxicity (stomatitis, myelosuppression, and phlebitis) occurred at the dosage level of 50 mg/sq m/day; and (c) no oncolytic responses were noted. Serum concentrations of total and free AMSA were assayed by a fluorescence technique and declined in a biphasic manner with free AMSA declining more rapidly than total AMSA. Dosages of greater than 100 mg/sq m/day were required to maintain serum concentrations of total and free AMSA greater than 0.2 microM for the entire five-day schedule. The results suggest that maximum tolerated dosages of AMSA may differ in children with leukemia and solid tumors; however, hematopoietic toxicity could not be fully evaluated in the patients with leukemia. AMSA has clear antileukemic activity that warrants future Phase II trials.

Adolescent↗
PubMed1980

High-dose methotrexate used alone and in combination for measurable primary or metastatic osteosarcoma.

High-dose methotrexate with leucovorin rescue was used alone or in combination with Adriamycin and cyclophosphamide for the treatment of 27 osteosarcoma patients with measurable indicators of disease. Three patients developed complete responses of measurable lesions, two had partial responses, two had static disease, one had symptomatic improvement, and one had return to normal of physical findings following treatment of a flat bone primary osteosarcoma. While the doses and frequency of administration of high-dose methotrexate differed from those used by previous investigators, these results suggest that aggressive treatment with high-dose methotrexate must be attempted to further evaluate its efficacy as single-agent therapy for osteosarcoma patients not eligible for adjuvant chemotherapy trials.

Antineoplastic Agents↗
PubMed1978

Childhood acute lymphocytic leukemia: study VIII.

This controlled study of children with ALL was designed to test the efficacy and toxicity of one-, two-, three- and four-drug therapy during remission and whether more aggressive therapy in the first eight weeks prolongs remission in patients with features associated with a particularly poor prognosis. After inducing remission with prednisone, vincristine and asparaginase, patients received cranial irradiation and IT methotrexate and were randomized to receive: 1--methotrexate alone; 2--methotrexate plus mercaptopurine; 3--same as in group 2 plus cyclophosphamide; and 4--same as in group 3 plus arabinosyl cytosine. Patients with CNS leukemia at diagnosis received IT methotrexate weekly during the induction period and a higher dose of CNS irradiation. Patients with anterior mediastinal enlargement at diagnosis received radiotherapy to the mass during the induction period. Patients who failed to attain bone marrow remission after four weeks of therapy were given daunorubicin and prednisone for 2--4 additional weeks. Of the 282 patients entering this study between January 1972 and November 1975, 268 (95%) attained complete remission and 228 (85%) were randomized to receive continuation chemotherapy with 1, 2, 3 or 4 drugs. In Group 1 (methotrexate alone), 14 of 20 patients relapsed and 9 developed leukoencephalopathy without antecedent CNS leukemia apparently due to higher doses of intravenous methotrexate; in Groups 2, 3 and 4 the results were equivalent, but without leukoencephalopathy in initial CR. The addition of cyclophosphamide and arabinosyl cytosine increased toxicity and complications without demonstrably increasing the leukemocidal effect. In the 40 patients given additional early therapy, the modalties employed in this study did not prolong remission.

Adolescent↗
PubMed1978

Phase I study of neocarzinostatin in children with cancer.

Twenty-three children with advanced cancer refractory to conventional therapy received weekly iv doses of neocarzinostatin for 5 weeks. Doses were escalated from 500 to 6750 units/m2/week. Four types of toxic manifestations occurred: acute reactions consisting of shaking chills with or without fever and cyanosis (rigor), hypersensitivity, vomiting, and marrow depression. Evidence of oncolytic activity was limited to patients with acute leukemia in whom phase II trials at doses between 3000 and 4500 units/m2 appear warranted.

Adolescent↗
PubMed1978

Combination chemotherapy for osteosarcoma.

Because of the great risk for development of pulmonary metastases following amputation for osteosarcoma, 24 consecutive patients with "clinically localized" osteosarcoma of an extremity were given adjuvant combination chemotherapy with adriamycin-cyclophosphamide-high-dose methotrexate-citrovorum factor. Thirteen of these patients remain free of tumor from 11 to 48 months following amputation. The median disease-free survival is estimated to be 18 months and the median survival 27 months. No relapses have been observed in any patients surviving free of disease beyond 23 months. Combination chemotherapy was also given to 16 patients whose disease was not localized; eight with pulmonary metastases at or following diagnosis, one with nodal metastases at diagnosis, two with osteosarcoma following radiation therapy for other malignant tumors, three with osteosarcoma of flat bones, one with parosteal osteosarcoma, and one with multifocal osteosarcoma. Three of this latter group of patients are surviving free of tumor at 8, 17, and 19 months from diagnosis. Two young patients died from complications of methotrexate and adriamycin toxicity.

Adolescent↗
PubMed1977

Adjuvant multiple drug chemotherapy for osteosarcoma of the extremity.

Results of treatment for osteosarcoma of the extremity have been poor with metastases usually causing death within 2 years following diagnosis. Because of the great risk of development of metastases, 20 patients have received adjuvant chemotherapy with Adriamycin, cyclophosphamide and high-dose methotrexate-leucovorin rescue for up to 12 months following amputation for osteosarcoma. Sixteen of these patients are surviving; 11 are free of evident tumor from 6 to 34 months following amputation. Five patients were found to have pulmonary metastases while receiving chemotherapy and three patients developed metastases following completion of chemotherapy. One patient died following her third treatment with high-dose methotrexate-leucorovin rescue. Other toxicity included nausea, vomiting, mucosal ulcerations, infections, hematologic abnormalities, changes in kidney and liver functions tests, and minor coagulation abnormalities. The natural history of osteosarcoma may have been modified by the use of these agents for periods exceeding the median time to predicted detection of pulmonary metastases. Microscopic metastases of some patients were eradicated by this adjuvant chemotherapy. For patients who developed metastases, these metastases were delayed in their time of detection and in their number at the time of detection.

Adolescent↗
PubMed1977

Colorectal carcinoma in adolescents implications regarding etiology.

Between October, 1974 and December, 1976, 13 adolescent patients with far-advanced, poorly differentiated colorectal carcinoma had been referred to a pediatric cancer center. All patients received chemotherapy with vincristine, methyl-CCNU and 5-fluorouracil. Five of 13 patients are living, one of whom remains disease-free after 12 months of chemotherapy. Four of the patients were from urban areas and nine from rural areas. One of four from urban areas had intimate exposure to chemicals used in the production of cotton and soy beans. Eight of nine patients from rural areas also had exposure to farm or agricultural chemicals, and three of these patients were intimately involved with the spraying operations. Suggestions regarding etiology and causative factors for the development of carcinoma of the colon in adults have previously been advanced. Results of these studies suggest that alternate etiologies must be suggested for adolescent colorectal carcinoma.

Adenocarcinoma, Mucinous↗
PubMed1977

Osteosarcoma during pregnancy.

Four white women who developed osteosarcoma during pregnancy were referred for treatment, 2 prior to delivery and development of metastases, and 2 after delivery and development of metastases. After amputation, these patients received combination chemotherapy with either vincristine-cyclophosphamide or adriamycin-cyclophosphamide followed by high-dose methotrexate with leucovorin rescue. Two patients survived, 1 tumor-free and 1 with bony and soft tissue metastases. Management of pregnant patients with osteosarcoma should include the use of adjuvant systemic chemotherapy to prevent detectable metastases. This treatment should follow amputation or resection and early termination of pregnancy.

Abortion, Induced↗
PubMed1977

Epipodophyllotoxin VM-26 in the treatment of childhood neuroblastoma.

Thirteen children with disseminated neuroblastoma that had become refractory to conventional chemotherapy were treated with the epipodophyllotoxin VM-26. Three patients developed partial responses (greater than 50% reductions in tumors and in the proportion of tumor cells in bone marrow). Acute nonhematologic toxicity after treatment was minimal. Hematologic toxicity was observed but could not be assessed accurately since most patients had abnormal hematopoiesis due to extensive tumor involvement of bone marrow. These results demonstrate that VM-26, as a single agent, can produce measurable tumor responses in children with neuroblastoma.

Blood Cells↗
PubMed1976

Recurrent childhood lymphocytic leukemia following cessation of therapy: treatment and response.

A unique population of patients--children who developed recurrent acute lymphocytic leukemia (ALL) following cessation of initial prolonged therapy--was studied. During a 2-year period, 17 such children were admitted to a planned combination chemotherapy program. Complete bone-marrow remissions were achieved in 16 patients, and the median duration of second hematologic remissions was 216 days. These responses were significantly better than those obtained in seven patients who relapsed during the administration of continuation chemotherapy. Although the rate and duration of induced remissions were notably high, 9 of the 17 patients who relapsed off therapy have again developed recurrent leukemia. This result, together with the moderate toxicity encountered during treatment, indicates that more therapy is needed. The equal proportion of bone marrow and meningeal relapses was interpreted to mean that a secon course of preventive central nervous system therapy early in remission may be especially useful.

Adolescent↗
PubMed1976

Comparison of the clinical course of Hodgkin's disease in children and adolescents.

In this study the clinical features and response to therapy of 34 children, 4--10 years of age, and 54 adolescents, 11--20 years of age, were compared. The therapeutic response in patients in this series entered on a formal protocol was compared with nonstudy patients. The 2 age groups had similar sex ratios, characterized by male predominance, and age was not a determining factor in the extent of disease at diagnosis. By contrast, the distribution of histopathology varied between children and adolescents: mixed cellularity was most prevalent in the 4--10-year group (14/34), while nodular sclerosis predominated the older patients (23/55). Remission induction and duration were not age dependent, but remission duration did differ between study and nonstudy patients. Forty-five of 57 patients in the former group remain in continuous complete remission compared to 7 of 31 in the latter group. From these results we conclude that the clinical course of Hodgkin's disease is similar in children and adolescents and that the agressive therapy combined with careful staging used so successfully in adults should be adhered to in younger patients.

Adolescent↗