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Biomedical subjects

G Schellong

Publications and source records attributed to G Schellong.

At least 55 records · Page 3Linked to original sources
PubMed1989

Chemotherapy for bone marrow relapse of childhood acute lymphoblastic leukemia.

Results of the BMF study group trials ALL-REZ 83 and 85 for relapsed acute lymphoblastic leukemia (ALL) are presented. For children with late marrow relapse, remission rates of about 90% were seen in both studies. In children treated for early marrow relapse, the remission rate in study ALL-REZ 85 was superior (86% vs 62%). The probability of event-free survival for all patients and for those with early marrow relapse was also statistically significant (P less than 0.05). Children with T-cell ALL had an extremely unfavourable prognosis in both studies.

Adolescent↗
PubMed1989

The effect of the number of fractions of cranial irradiation on growth in children with acute lymphoblastic leukaemia.

Growth was documented over a period of 7 years in all long-term survivors treated for acute lymphoblastic leukaemia (ALL) with the DAL-70- (n = 15) and BFM-70-protocol (n = 27). Normal growth was documented in patients of the DAL-70-protocol during and after therapy. In contrast, in children treated with the BFM-70-protocol the mean height standard deviation score (SDS) decreased significantly from 1.21 SDS prior to therapy to 0.80 SDS at the end of therapy (p less than 0.001) and remained unchanged thereafter. Prophylactic cranial irradiation was given in total doses of 15 to 30 Gy. Ten children of the DAL-70- and 20 children of the BFM-70-protocol received 24 Gy of cranial irradiation. No significant change in height-SDS was observed in any patients of the DAL-70- and in 8 patients of the BFM-70- group, who received 24 Gy of cranial irradiation in 16-26 fractions. Adult height in 7 girls and 6 boys was normal and 3.15 cm and 5.06 cm above target height. In the remaining 12 patients of the BFM-70-protocol the total dose of 24 Gy of cranial irradiation was applied in 11-14 fractions. Their height-SDS had fallen significantly from 1.24 SDS before to 0.66 SDS (p less than 0.001) at the end of therapy. Adult height in 4 girls and 6 boys was also normal, but the height increase was comparatively smaller, -2.20 cm below target height in the girls and 1.91 cm above in the boys.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

The results of short-term (6 months) high-dose testosterone treatment on bone age and adult height in boys of excessively tall stature.

Forty-nine pubertal tall boys with a mean height prediction of 203.59 cm according to the Bayley-Pinneau (BP) method were treated prospectively with 500 mg testosterone-oenanthate every 2 weeks for a period of 6 months. Before therapy chronological age (CA) was 14.14 years and bone age (BA) 13.88 years using the Greulich-Pyle (GP) method. During therapy BA advanced by 1.37 years. It continued to accelerate during the 6 months following therapy with a mean delta BA/delta CA being 3.01 at 3 months and 2.24 at 6 months after therapy. The 6 months value was only slightly less than the delta BA/delta CA of 2.47 obtained during therapy. The reduction in adult height was 7.26 cm or 50.8% of the predicted further growth in 12 boys with a long-term follow up of 2.5 years. This is similar to the 51.6% or 9.63 cm observed in 50 boys with a long-term follow up after 14.25 month treatment until a BA of 17 years or more. It is concluded that in the majority of cases high-dose testosterone therapy in boys of tall stature can be limited to a 6-month treatment period. Reassessment of the height prediction after a 6-month interval without therapy should define those patients who have to resume treatment because of their remaining excessive growth potential.

Adolescent↗
PubMed1988

An approach to reduce treatment and invasive staging in childhood Hodgkin's disease: the sequence of the German DAL multicenter studies.

UNLABELLED: From June 1978 through March 1987, 506 children under the age of 16, representing approximatively 70% of the children with Hodgkin's disease in West-Germany entered 3 consecutive multicenter studies at 68 centers. The general objective of these study sequence is to maximize the chance of cure while minimizing radiotherapy and chemotherapy as much as possible in a combined modality treatment concept. The purpose was also to reappraise the need for splenectomy and laparotomy and to define a staging policy which provides adequate evaluation of intraabdominal disease. Study II (HD-82) is described in detail. 203 protocol patients were enrolled between Dec. 1981 and Dec. 1984. Laparotomy was performed in 202 patients, but splenectomy only in 78 (38.4%) using an intraoperative decisional strategy, developed in Study I (HD-78). Patients were stratified according to stage into 3 groups (PS I/IIA, IIB/IIIA and IIIB/IV) receiving 2, 4 or 6 cycles of OPPA/COPP-chemotherapy. Radiotherapy was given only to the involved fields, the dose depending on the extent of chemotherapy (35, 30 or 25 Gy). RESULTS AND CONCLUSIONS: The event-free survival rates after 5 years are 96% (entire group), 99% (stage I/IIA), 96% (stage IIB/IIIA) and 90% (stage IIIB/IV). Thus, only involved field radiotherapy with reduced doses is needed, if a stage-dependent chemotherapy with 2, 4 or 6 cycles of OPPA/COPP is given. The strategy of selective splenectomy has proven very useful. Based on statistical analyses concerning abdominal involvement a clinical decisional strategy for selective laparotomy was developed. Further efforts are needed to reach a stepwise cautious and controlled narrowing-in on the therapy combining the lowest long-term toxicity with the highest chance of cure.

Adolescent↗
PubMed1987

Early deaths due to hemorrhage and leukostasis in childhood acute myelogenous leukemia. Associations with hyperleukocytosis and acute monocytic leukemia.

There were 294 children with acute myelogenous leukemia (AML) entered into the German AML Berlin, Frankfurt, and Münster hospitals (BFM) 78 and 83 studies. Thirty (10%) died as a result of hemorrhage and/or leukostasis prior to or in the first 12 days of therapy. The risk of early death due to hemorrhage and/or leukostasis is significantly greater when certain features are initially present: acute monocytic leukemia (French-American-British [FAB] M5), hyperleukocytosis (greater than or equal to 100,000/microliter), and extramedullary organ involvement (P less than 0.001). The risk increases sharply when these factors exist in combination: 72% mortality with FAB M5 and hyperleukocytosis, and 43% with FAB M5 and extramedullary organ involvement. In 11 patients leukostasis alone or in combination with hemorrhage was probably the cause of death during the first 3 days after diagnosis. All 11 children presented with hyperleukocytosis and were classified as monocytic subtype FAB M4 or M5. After induction, a close temporal association between rapid blast reduction and occurrence of fatal hemorrhage was established in five patients. Thrombocytopenic hemorrhages were controllable and, therefore, responsible for death only in exceptional cases. It is difficult to avoid these early fatal complications with current therapeutic measures. Early exchange transfusion together with special supportive care may be useful.

Adolescent↗
PubMed1987

[High dosage ARA-C in combination with mitoxantrone in therapy of acute myeloid leukemia in childhood. Initial results of the AML BFM-85 recurrence study].

19 children with AML were treated using the combination of high dose cytosine-arabinoside and mitoxantrone. All children were initially treated according to protocol AML-BFM-83. 6 children with refractory AML, 9 children with bone-marrow relapse during or after maintenance therapy and 4 children with residual blasts (5-25%) after remission induction and consolidation therapy AML-BFM 83 were treated with the relapse protocol. 6 of 15 children with refractory AML and all 4 children with residual blasts achieved a complete remission. 2 children died in bone-marrow aplasia and 1 child did not respond. One child died after further mitoxantrone treatment due to toxic cardiomyopathy. All children went into severe bone marrow aplasia, which lasted in median 27 days. These data indicate a high antileukemic activity of HD-ARA C/mitoxantrone in childhood AML.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Prediction of splenic involvement in children with Hodgkin's disease. Significance of clinical and intraoperative findings. A retrospective statistical analysis of 154 patients in the German therapy study DAL-HD-78.

In 154 splenectomized children and adolescents with histologically proven Hodgkin's disease in the therapy study DAL-HD-78, the incidence of splenic involvement was 39%. In single-parameter analyses 6 of 16 examined pre- and intraoperative findings showed significant correlation to splenic involvement: B-symptoms, palpable splenic enlargement, mediastinal/lung hilus involvement, nodular changes of splenic surface, enlarged lymph nodes at splenic hilus/pancreatic tail, or enlargement of other upper-abdominal lymph nodes. The results of multivariant analyses (Cox regression model) of these six parameters showed that the two most significant intraoperative parameters--changes of splenic surface and enlargement of lymph nodes at splenic hilus/pancreatic tail-gave almost all of the information which can be obtained about splenic involvement. With these two parameters, an intraoperative decisional strategy for selective splenectomy has been developed which allows the omission of splenectomy in about two thirds of children with Hodgkin's disease while still obtaining detailed information about infradiaphragmatic spread of disease. Since minor splenic involvement remains undetected in about 10% of the nonsplenectomized patients (i.e., 6% of all patients), this method should be used only in combination with chemotherapy.

Adolescent↗
PubMed1986

Frequency and clinical significance of DNA aneuploidy in acute leukemia.

Analyses of the cellular DNA content were carried out in 446 patients with newly diagnosed acute myeloid (AML) and lymphoblastic (ALL) leukemias in order to assess the frequency of DNA aneuploidies and its relation to immunologic and morphologic subtypes as well as its prognostic relevance. Based on high resolution FCM analyses and standardized reference measurements, DNA aneuploidies were identified at a similar frequency in children and adults with AML (38.0% and 40.0%) and ALL (40.0% and 37.4%). In AML aneuploid DNA stemlines were significantly less frequent in FAB-M 1 cases as compared to the other morphologic subtypes (p less than 0.05), whereas the degree of DNA aneuploidy was significantly lower in M 1 and M 2 leukemias as compared to the M 4 and M 5 subgroups (p less than 0.05). In ALL non-T/non-B and C-ALL revealed a higher frequency of DNA aneuploidies than T- and Null-ALL cases (p less than 0.05). No differences in the response to induction therapy were found between patients with and without DNA aneuploidy in children or adults with AML or ALL. In the childhood ALL trial BFM 79/81, however, a significantly higher frequency of long term remissions was observed in children with DNA aneuploidy (0.91 versus 0.66 at five years, p = 0.053). A similar though not significant tendency was also revealed from the AML studies BFM 78 in children and 78/81 in adults. In the subsequent studies these differences could not be confirmed at present, possibly because of the considerably shorter observation time.

Adult↗
PubMed1986

[Risk groups in acute, non-lymphatic leukemia in childhood. Analysis of the results of the cooperative therapeutic studies AML-BFM 78 and 83].

The analysis of the treatment results of the co-operative therapy studies BFM 78 and 83 for the treatment of acute myelogenous leukemia in children revealed the following risk factors: Death before the onset of therapy and early death occurred more frequently in children with acute monoblastic/monocytic leukemia and in children with initial WBC of greater than 100,000/microliters than in the other patient groups. The remission rate was lower in children with an initial WBC greater than 100,000/microliters (56%) than in children with an initial WBC less than 100,000/microliters (86%). In study BFM 78 the probability of a relapse free interval of 6 years is significantly lower in children with an initial WBC greater than 100,000/microliters (pCCR = 28%; SD 11%) than in children with an initial WBC less than 100,000/microliters (pCCR = 64%; SD 10%). The median follow up time is 4 3/4 years (range 2 3/4-6 3/4 years). The probability of an event free interval of 3 years was significantly lower in children with initial involvement of the CNS (pCCR = 24%, SD 12%) than in children without involvement of the CNS (pCCR = 50%; SD 5%).

Adolescent↗