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Biomedical subjects

G Schellong

Publications and source records attributed to G Schellong.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

[Treatment of recurrence of acute myeloid leukemia in childhood. A retrospective analysis of recurrence in the AML-BFM-83 study].

Complete remission (CR) rates of 80% are achieved with the AML-BFM protocols but one third of patients relapse within the first three years. There are few reports of treatment of relapsed childhood AML, and these deal with the evaluation of new drugs for frontline therapy. We performed a retrospective analysis to investigate how patients previously treated with the AML-BFM-83 protocol were treated after relapse and how many long term remissions were achieved. 48 of 139 patients relapsed after having achieved complete remission with the AML-BFM-83 protocol which consists of continous infusion of ARA-C 100 mg/m2 day 1-2, ARA-C 200 mg/m2 day 3-8, Daunorubicin 60 mg/m2 day 3, 4, and 5, and VP-16 150 mg/m2 day 6, 7, and 8, and an 8 week consolidation therapy consisting of Prednisolone, Thioguanine, Vincristine, ADR, ARA-C, Cyclophosphamide, intrathecal ARA-C and cranial irradiation followed by maintenance therapy. Duration of first remission ranged from 1.5 months to 66.3 months. Excluding 5 children with either isolated or combined extramedullary relapses and another 4 patients for missing data, 39 children were evaluable. 20 children received no therapy or palliative therapy while 16 patients received chemotherapy and another 3 children were transplanted in relapse. Although 9 different intensive chemotherapy regimens were used for reinduction, a high number (12 of 16 = 75%) of second complete remissions was achieved. Several therapeutic options were used to maintain a second remission: regular maintenance therapy (7 patients), allogeneous bone marrow transplantation (BMT) (2 patients), autologous BMT (3 patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Ifosfamide and the metabolites of side chain oxidation--excretion in urine in various pediatric therapeutic protocols].

The precondition for the antineoplastic effect of ifosfamide (Ifo) is the oxydation of the oxazaphosphorine ring system. The 'ring oxidation' by several steps leads to the formation of alkylating mustard. A second metabolic pathway results in the cytostatically inactive metabolites 2- and 3-deschlorethyl-ifosfamide (2-, and 3-d-Ifo). This 'side chain oxidation' plays a quantitatively more important role with ifosfamide than with cyclophosphamide. The urinary excretion of unmetabolized Ifo and of 2- and 3-d-Ifo, which represents the amount of Ifo not activated, has been investigated by capillary gaschromatography in 18 treatment cycles of 14 children with various therapeutic schedules (800, 2000 and 3000 mg/m2 given as bolus, over 1 h or as continuous infusion for 2 respectively 5 days). The total cumulative excretion during 12 completely sampled cycles ranged from 27 to 50% of the given Ifo. Between 14 and 34% could be detected as IFO, 9 to 29% as 3-d-Ifo and 2 to 8% as 2-d-Ifo. In 4 children the amount of 'side chain oxidized' IFO exceeded the amount of unmetabolized Ifo. 24 hours after the end of therapy excretion is nearly complete. No relationship between the excreted amount of unmetabolized Ifo, 2-d-Ifo and 3-d-Ifo and the dose schedule could be determined. There was no clearcut dependency between cumulative dose, the children got in the past, and formation of 2- and 3-d-metabolites.

Adolescent↗
PubMedDate not supplied

[Recommendations for the structure and equipment of pediatric oncologic centers].

The yearly incidence of cancer in children and adolescents within Germany is about 2200. The regular medical care for these children is effected within prospective multicenter trials of the DAL and GPO respectively. These trials achieved excellent results and gained high international reputation. Following an initial funding by the Bundesministerium für Forschung und Technology the continuation of these trials nowadays is fully dependent on private third parties financial aid especially from the Deutsche Krebshilfe. Guarantee of progress in clinical research and of improvement in patient care as well is closely related to establishing pediatric cancer centers. Accruing about 80 new patients per year such centers have an optimum size justifying establishing stabile substructures. Integrated basic research and organization of special clinical domaines need a differentiated structure of management and a sufficient number of qualified personnel in time nonlimited positions. The recommendation of the Arbeitsgemeinschaft Deutscher Tumorzentren from 1979 for personnel equipment is largely insufficient with respect to the inpatients nursing staff for pediatric oncology units. A basic equipment of 1.75 nurses per patient and additional nursing staff with specific functions would seem appropriate as demonstrated by analyses and calculations within the last part of our recommendations. The ADT recommendations are also insufficient with respect to secretaries and documentation assistants. Concerning the physicians staff the ADT recommendations just need an adaption to the changes in working time in accordance with the tariffe. These recommendations, however, urgently need to be realized. The necessary staff for psycho-social work has been incorporated into our recommendations for the first time. The ratio of patient rooms to function rooms (excluding laboratories) in pediatric oncology centers diposing of an outpatient area and a day clinic should be about 1:3. Deficiencies in the personnel equipment and the generally pronounced lack in function rooms as well are hampering the daily work and have negative impact on the quality of care as experienced by the patient on the safety of medical and nursing practice and on the quality of teaching, medical education and advanced training.

Cancer Care Facilities↗
PubMedDate not supplied

[Testicular function after OPA/COMP chemotherapy without procarbazine in boys with Hodgkin's disease. Results in 25 patients of the DAL-HD-85 study].

Gonadal function was evaluated in 25 boys treated for Hodgkin's disease according to the DAL-HD-85 protocol with OPA- or OPA/COMP-chemotherapy (vincristine-prednisone-adriamycine/cyclophosphamide-vincristine-m ethotrexate- prednisone). All boys were in first continuous complete remission for 6 to 45 months at chronological ages varying from 14.0 to 18.9 years. Testosterone, basal and GnRH-stimulated LH- and FSH-levels were measured. Gonadal function was normal in 16 patients treated with 2 cycles of OPA-chemotherapy in Hodgkin stages I-IIA. 9 patients were treated with 2 OPA- and 2 or 4 COMP-cycles of chemotherapy and had received mean cyclophosphamide doses ranging from 2004 to 3722 mg/m2. Again, no major testicular damage was noted, though some patients had increased stimulated LH-levels possibly indicating compensated Leydig cell-insufficiency. Our results demonstrate, that testicular function is not severely affected when patients are treated for Hodgkin's disease without procarbazine even if cyclophosphamide is given in cumulative doses below 3800 mg/m2. The previously documented severe testicular damage in boys treated according to the DAL-studies HD-78 and HD-82 is thus a result of the gonadotoxic action of procarbazine.

Adolescent↗
PubMedDate not supplied

[Transient myeloproliferation and acute myeloid leukemia in infants with Down's syndrome].

Transient neonatal myeloproliferative disorders (TMD's) indistinguishable from acute leukaemia by clinical and morphological criteria have been described in neonates with Down's syndrome. To analyse its clinical significance, 10 infants under 1 year of age presenting with Down's syndrome and the morphological picture of acute myelogenous leukaemia were reviewed. 3 of these children had true AML leading to death after 2, 8 and 11 months. In the other 7 children the diagnosis TMD was suggested as spontaneous or in one case interferon-induced remission occurred within 4 to 25 weeks after diagnosis. The interferon-treated patient died of SIDS at the age of 11 months. Another one of the TMD children developed fatal erythroleukaemia at the age of 2 years. Regarding initial clinical and haematological parameters, TMD was indistinguishable from true congenital leukaemie. In all patients classification according to the FAB criteria was difficult, as mainly undifferentiated or poorly differentiated myeloid blasts were seen, sometimes with erythro- or megakaryocytic features. Because of the difficulties in the differential diagnosis of TMD and true AML it is recommended to delay specific cytostatic therapy in neonates with Down's syndrome, until definite progression of the leukaemic process is observed or cytogenetic analyses suggesting true AML are available.

Antigens, CD↗
PubMedDate not supplied

[Acute myelogenous leukemia in children under 2 years of age: studies and treatment results in 23 children in the AML therapy study BFM-78].

23 out of 151 patients of the childhood AML study BFM-78 were less than two years of age at the time of diagnosis, 10 of them being less than one year old. The incidence of M5-subtype was high in infants with 12/23 (52%) compared with 20/128 (16%) in those 2 to 17 years of age. The percentage of boys was 44% in the young children compared with 56% in the older ones. Initial skin infiltrations were seen in five infants with monoblastic subtypes (M4, M5) and in only three patients more than two years of age. The incidence of liver and spleen enlargement greater than or equal to 5 cm below the costal margin was significantly higher in young children. Due to infectious complications frequent therapy-free intervals and/or reduced drug dosages were necessary in the 8-week induction treatment regimen. The prophylactic cranial irradiation with 12 Gy in the first year of life and 15 Gy in the second year has so far not caused any long-term sequelae. The results were similar to those in older children: 18/23 (78%) of the infants achieved complete remission compared with 101/128 (79%) of those 2 to 17 years old. With a follow-up period of 16 to 49 months the probability of continuous complete remission (disease-free interval) was 52% in children under the age of 2 and 54% in those more than 2 years of age. We conclude that with the improved prognosis an intensive chemotherapy is justified in infants with acute myelogenous leukemia.

Adolescent↗
PubMedDate not supplied

[BFM study 1981/83 of the treatment of highly malignant non-Hodgkin's lymphoma in children: results of therapy stratified according to histologic immunological type and clinical stage].

99 children with non-Hodgkin's lymphoma entered the prospective, multicenter BFM study 81/83. They were treated with a four-fold stratified therapy according to clinical stage and origin of the lymphoma from B- or non-B-lymphocytes. In the BFM study 75/81, these criteria had been proven to be most relevant for prognosis. Therapy of non-B-NHL was very similar to the therapeutic concept as applied in acute lymphoblastic leukemias by the BFM group. For the NHL of B-type, a new therapeutic regimen was developed. Cytostatic drugs applied in this group were: medium dose methotrexate, cyclophosphamide in a fractionated manner of application, adriamycin, cytarabine, VM 26 and prednisone. The probability of disease-free survival was 80% after nearly 3 years for all patients. In non-B-NHL it was 89% in localized, and 79% in disseminated disease. All patients with localized B-NHL are surviving without relapse, while the probability of disease-free survival in patients with disseminated B-NHL was 67%. Thus, the therapy result in the latter group was doubled as compared to the result of the BFM study 75/81.

Adolescent↗
PubMedDate not supplied

[Hemostasis and fibrinolysis in acute lymphoblastic leukemia (ALL) in childhood--analysis of life-threatening bleeding].

66 children with ALL, who were admitted to the University Children's Hospital at Münster for treatment according to the BFM protocol 79/81, presented initially with the following abnormal hemostatic parameters: Prolongation of bleeding time (89%), thrombocytopenia (83%), pathological prothrombin time (69%), increased FDP (32%, reduced F XIII (33%), abnormal short PTT (34%). There was a significant discrepancy between immunologically and functionally measured fibrinogen, which is only partially explained by the presence of FDP. Patients with T-cell leukemia (n = 11) had significantly higher WBC, longer prothrombin times, and lower fibrinogen levels than patients with Non-T/non-B ALL. The initial coagulation parameters did not discriminate the 6 patients who presented life threatening bleeding episodes. The two patients with high blast count (350 000 and 548 000/mm3) and T-ALL had intracranial bleeding before therapy started; in one of them vascular infiltration of blast cells was demonstrated at autopsy. Two other patients had bacterial infections, which in one case led to local bleeding into the lungs and in the other case to DIC. Two further children presented intracranial bleeding episodes which could be associated with asparaginase therapy. 5 of the 6 patients with life threatening episodes had a platelet count of more than 35 000/mm3.

Adolescent↗
PubMedDate not supplied

[Determination of methotrexate concentration in serum: comparison between capillary and venous blood].

The methotrexate serum concentrations of 15 patients were measured in capillary and veneous blood samples. All of the patients had received methotrexate infusions because of their underlying oncologic disorder. The drug levels of 42 pairs of capillary and veneous drawn serum samples were analysed with a homogeneous enzyme immunoassay technique on a semi-automatic instrument system. In 15 pairs of samples the drug levels were below the range of the assay, in 3 they were just above. Here the capillary samples were measurable, whereas the veneous ones were not. 24 pairs of samples which had drug levels within the range of the assay showed a good correlation of capillary and veneous serum levels. The correlation factor of 0.934 shows, that the methotrexate concentrations can also be measured in capillary blood samples.

Bone Neoplasms↗
PubMedDate not supplied

[Combined treatment strategy in over 200 children with Hodgkin's disease: graduated chemotherapy, involved field irradiation with low dosage and selective splenectomy. A report of the cooperative therapy study DAL-HD-82].

UNLABELLED: It was the aim of the cooperative therapy study HD-82 for children with Hodgkin's disease to reduce chemo- and radiotherapy and to investigate of a strategy for selective splenectomy previously developed in the Hodgkin study HD-78. Between December 1981 and December 1984 207 patients (131 boys and 76 girls) below 16 years of age were enrolled in this study. In 174 out of 207 patients (84.1%) the criteria for selective splenectomy were applied i.e. the spleen was only removed when the splenic surface was nodular or when the lymphnodes at the splenic hilus and/or the pancreatic tail were enlarged. 69 out of 174 patients (39.7%) had a splenectomy. 50 of the removed 69 spleens (72%) showed histological evidence of Hodgkin's disease. These results were comparable to the 36% and 73% predicted from the retrospective analysis in the HD-78 study. According to the stage of Hodgkin's disease three different treatment groups with 2, 4 and 6 cycles of OPPA/COPP were formed (stage I/IIA, IIB/IIIA and IIIB/IV). Radiation therapy was given as involved field irradiation with a total dose of 35, 30 and 25 Gy depending on the extent of the chemotherapy. 203 patients were treated according to the protocol. Until the 30th of November 1985 3 patients died from intercurrent disease during a follow-up period of 11 to 47 months (median 29 months). 5 patients relapsed. The probability for disease-free survival after 3 1/2 years is 96% for the total group and 99%, 96% and 87% for the three treatment groups including 100, 53 and 50 patients in each group respectively. CONCLUSIONS: 1. The OPPA/COPP chemotherapy eliminates reliably occult microfoci. 2. The radiation doses in combination with the chemotherapy are sufficient to prevent local recurrences. 3. The decisional model for selective splenectomy has proved to be extremely valuable prospectively.

Adolescent↗
PubMedDate not supplied

[Results of ultrasonic, computer tomography and clinical findings for the detection of abdominal involvement in Hodgkin's disease in childhood--a retrospective statistical analysis of 145 patients in the therapeutic study DAL-HD-82].

It was the aim of the study to develop a method that would fairly reliably predict abdominal involvement in patients with Hodgkin's disease. Using sonography (SG), computerized tomography (CT) and clinical findings we wanted to restrict laparotomy to patients with a high probability of abdominal involvement. 145 patients of the therapy study HD-82, who had preoperative abdominal SG or CT, were analyzed. All had a laparotomy, 61 had a splenectomy and 9 a partial splenectomy. The incidence of abdominal involvement was 36%. Using 2 X 2 contingency tables as well as the X2-test 7 out of 13 parameters tested had a highly significant correlation to abdominal involvement. These 7 parameters were analyzed with the linear-logistic regression model of COX. The three most valuable individual parameters "abdomen in SG and/or CT abnormal", "B-symptomatology" and "involvement of the hilar lymphnodes of the lung" contain almost all the information concerning abdominal involvement. All the other parameters are no longer significant when used in combination with these three and thus can be disregarded. For practical purposes one can omit the "B-symptomatology" as well, because the combination of the other two parameters has the smallest number of false positive results, while the number of false negative results is only slightly increased. Using these data we developed a decisional model for selective laparotomy, which allows a 50% reduction of laparotomies. This method can only be used in combination with a therapy concept that contains chemotherapy for all patients.

Abdominal Neoplasms↗
PubMedDate not supplied

[Therapy realization and complications in the BFM-83 therapy study of acute myelogenous leukemia].

Data on the realization of therapy are available for 159 out of 173 (92%) protocol patients included in the study AML-BFM-83. The induction therapy could be carried out according to protocol in almost 80% of patients, with a dose compliance (= actual dose/prescribed dose) of greater than or equal to 80% for all substances. During the second therapy phase (consolidation) considerable deviations from the recommended therapy occurred in all nonresponders and in 34% of the patients who had achieved remission. The maintenance therapy had to be reduced in one third of the patients, mainly due to thrombopenias. Lethal complications caused by therapy-induced toxicity, occurred in 7 out of 173 cases (4%), and followed severe infections (mycoses), or other complications such as cardiotoxicity. The proportion of severe complications decreased from the induction through the first to the second consolidation phase. They were rare during maintenance therapy, but markedly more frequent in nonresponders and in children with early relapse (within 12 months). In view of the small differences in dose compliance, it is difficult to determine the prognostic significance of the realization to therapy. With the application of the COX regression and special life table analyses the dose compliance decreases in significance after including the known initial prognostic factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Significance of procarbazine in the chemotherapy of Hodgkin's disease--a report of the Cooperative Therapy Study DAL-HD-85].

It was the objective of the DAL study HD-85 to examine the possibility of a reduction of chemotherapy, compared to the study HD-82 which had applied a combined treatment strategy resulting in a relapse rate of only 2.5% after 4 years, and a proportion of intercurrent deaths of 1.5%, in a total of 203 patients. Procarbazine was eliminated in the OPPA-therapy (OPA) and replaced by methotrexate in the COPP-cycles (COMP). Chemotherapy consisted in 2 cycles of OPA for stage I/IIA (group 1), 2 cycles of OPA and 2 cycles of COMP for stage IIB/IIIA (including IEA/IIEA) (group 2), and 2 cycles of OPA and 4 cycles of COMP for stage IIIB/IV (group 3). The subsequent radiotherapy was limited to the initially involved fields, the dosage of 35, 30 or 25 Gy depending on the extent of chemotherapy. Regions showing incomplete tumor regression after chemotherapy received another 5 Gy, in patients of groups 2 and 3. Between Jan. 1985 to Nov. 1986, 103 children with Hodgkin's disease from 42 participating hospitals were enrolled in this study. 98 patients were treated according to protocol (59 boys, 39 girls). A specific strategy for the selective indication of laparotomy and splenectomy was applied. With this strategy no laparotomy was performed in 39/98 patients (40%). 67 patients (68%) retained their spleen. 4 patients showed progression of the disease under chemotherapy, all others achieved remission. 16 patients relapsed before Dec. 31, 1987. So far no child of this study has died.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Cooperative osteosarcoma study COSS-77: results after 4 years].

71 patients with resectable osterosarcoma received chemotherapy for one year including high-dose methotrexate (18 x 200 mg/kg), adriamycin (5 x [2 x 45] mg/m2) and cyclophosphamide (6 x 1200 mg/m2). During the initial 15 weeks adriamycin was used preferentially and cytostatic agents were applied in a higher frequency than later on. 41/71 patients are continuously free of disease with a median follow up of 39 (24-54) months. The latest appearance of pulmonary metastases was observed at 28 months so far. 18/27 (67%) patients with extension of tumor lesion beyond 1/3 long bones length by x-ray examination relapsed in contrast to 12/43 (28%) patients with smaller lesions. 1 patient died from adriamycin induced cardiomyopathy. Generally therapy was well tolerated. An average of 70-80% of planned drug dosages could be realized without measurable influence of individual differences on outcome.

Adolescent↗