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Biomedical subjects

K D Waters

Publications and source records attributed to K D Waters.

36 records · Page 2Linked to original sources
PubMed1983

Results of treatment of 18 children with Hodgkin disease with MOPP chemotherapy as the only treatment modality.

Eighteen children with Hodgkin disease (16 previously untreated; two relapsed) were treated with MOPP chemotherapy (nitrogen mustard, vincristine, prednisone, procarbazine) only. Ten had clinical stage I and II disease, four had stage III, and four had stage IV. In ten patients, the clinical stage was confirmed by staging laparotomy. Six courses of MOPP were given to eight stage I and II patients and two stage IV patients. Between 7 and 12 courses were given to two stage I and II, and six stage III and IV patients. Dose reduction of 75-50% was required in 13% and delay of treatment in 22% of the first six courses of MOPP. Hematologic toxicity, minor and major viral infections, and nausea and vomiting were the major complications. Complete remission (CR) was obtained in 17 patients. Of these 17, there has been one death in CR, and one relapse. Sixteen patients have discontinued treatment and have been observed off treatment for 8 months to 7.5 years. The actuarial disease-free survival with a median follow-up of 28 months is 80% and overall survival is 92%.

Adolescent↗
PubMed1983

The treatment of Wilms' tumor: results from Royal Children's Hospital, Melbourne, 1967-1977.

A retrospective review of the treatment of Wilms' tumor from 1967 to 1977 at the Royal Children's Hospital, Melbourne, was undertaken, allowing a minimum 2-yr followup. Fifty-four (77%) of the 70 patients in the study are alive, with 23/25 (92%) in Stage I, 12/16 (75%) in Stage II, 12/19 (63%) in Stage III, and 7/9 (78%) in Stage IV. Survival was significantly better in Stage I disease, and those patients less than 5-yr-old at presentation. Recurrence of disease was significantly lower after the introduction of multiple courses of chemotherapy in 1971. Sixteen deaths occurred during the period: three infants from drug toxicity, four patients with "unfavorable" sarcomatous histology, and four patients with recurrent local disease, where irradiation had been confined to the tumor bed after tumor spill with recurrence beyond the irradiated field.

Abnormalities, Multiple↗
PubMed1983

VM-26 and dimethyl triazeno imidazole carboxamide in Ewing's sarcoma.

Twenty-seven patients with biopsy proven Ewing's sarcoma were randomised to receive one of two adjuvant chemotherapy regimens for two years. Group A were given monthly courses of vincristine, adriamycin and dimethyl triazeno imidazole carboxamide (DIC); Group B received monthly courses of VM-26, adriamycin and DIC. Chemotherapy was commenced after biopsy confirmation of disease. The primary tumour was treated with irradiation to 3,000-5,000 rad and by resection in three patients. With a median follow-up of 26 months, 52% of patients are disease free. Ten patients died, seven from recurrent disease and three from complications of treatment. There was a significant difference in disease free survival rate of patients with long bone lesions (11/12) compared with patients with flat bone lesions (6/15). The disease free survival rate of Groups A and B was similar. Our results suggest that in combination chemotherapy for Ewing's sarcoma, vincristine and VM-26 have similar anti-tumour activity.

Adolescent↗
PubMed1982

Autologous bone marrow rescue in the treatment of advanced tumors of childhood.

High-dose multiagent chemotherapy followed by autologous marrow rescue was used in the treatment of 13 patients with Stage III or IV childhood tumors. Encouraging results are being obtained in abdominal lymphoma (1/3 complete remissions (CR); rhabdomyosarcoma (2/4 CR); and retinoblastoma (1/2 CR). In neuroblastoma, the results are disappointing, with only one of four patients in CR; this patient developed a lymphoma associated with Epstein-Barr virus infection. Marrow reconstitution was obtained in 11 patients, with recovery of neutrophils to greater than 0.5 x 10(9)/liter between six and 30 days and platelet recovery to greater than 50 x 10(9)/liter between seven and 38 days. Investigations on the numbers of cells or committed granulocyte precursors ()CFU-c's) infused and parameters of hematologic recovery show poor correlation and suggest that a more accurate and reliable assay for the predictability of cryopreserved marrow to reconstitute marrow function within a reasonable time is necessary. Nonhematologic toxicities of high-dose multiagent chemotherapy are the principal dose-limiting factors.

Adolescent↗
PubMed1982

Treatment of acute myeloid leukaemia in children.

Complete remission was achieved in 11 of 22 children with acute myeloid leukaemia using at least two courses of a 24 hour infusion of cytosine arabinoside (Ara-C) 10 mg/kg, followed by push injections of daunorubicin (DNR) 45 mg/m2, and adriamycin (ADR) 45 mg/m2. Consolidation therapy consisted of three courses of Ara-C and 6-thioguanine (Tg) and one course of cyclophosphamide (CPA) and ADR. Central nervous system prophylaxis with intrathecal Ara-C was given in all patients and cranial irradiation of five. Maintenance therapy consisted of 5 day courses of Ara-C and Tg given 4 weekly with immunotherapy (BCG) vaccine and subcutaneous leukaemic cells) between courses. Median length of first complete remission was 99+ weeks, and median survival of all patients was 44 weeks. Median survival of remitters was 195+ weeks and non-remitters, 28 weeks. Two patients developed central nervous system disease, one at presentation and the other 46 weeks from presentation. Five patients have ceased therapy and remain in remission from 32 to 142 weeks after ceasing treatment.

Adolescent↗
PubMed1981

Results of cessation of treatment in childhood acute lymphocytic leukaemia.

From 1972 to 1977, 55 of 161 children with acute lymphocytic leukaemia discontinued treatment after being in continuous complete remission for three years. A low total white cell count as diagnosis (less than 10 X 10(9)/L) was significantly associated with cessation of therapy, but there was no significant association with age or sex. Nine patients have relapsed, all but one within 50 weeks of cessation of treatment. Testicular relapse occurred only in one patient. Actuarial complete remission rate with a median duration of follow-up 140 weeks was 76%, and there was no significant sex difference. It is proposed that the relatively good prognosis in boys after cessation of therapy may be related to limited use of steroids during induction chemotherapy.

Child↗
PubMed1980

Prophylactic co-trimoxazole and lactobacilli preparation in neutropenic patients.

A randomized study of intestinal decontamination was undertaken in 68 children with leukemia and solid tumours. Framycetin, colymycin, nystatin, and metronidazole were given in 35 neutropenic episodes in 33 children, while co-trimoxazole and lactobacilli preparation were administered in 35 episodes in 35 children. The diseases, severity of neutropenia, and incidence of infection at entry into study were comparable in the two groups. There was no significant difference in the incidence of infections developing during the phase of neutropenia. The median and range of time required to recover from neutropenia were also not different. Co-trimoxazole and lactobacilli were significantly better tolerated, there being no nausea and vomiting, no refusal to take medication, no dose reduction or change to an alternative regimen. We conclude that co-trimoxazole and lactobacilli preparation improve quality of life during a neutropenic episode and have the additional advantage of being relatively inexpensive.

Agranulocytosis↗
PubMed1980

Management of the more common pediatric neoplasms with particular reference to Hodgkin's and non-Hodgkin's lymphoma, Wilms' tumour and neuroblastoma.

Accurate pathological diagnosis and staging of extent of disease are key steps in the management of childhood neoplasms. Adjuvant chemotherapy is responsible for improved survival rates. In non-Hodgkin's lymphoma intensive chemotherapy, irradiation to areas of bulk disease and central nervous system prophylaxis are combined in treatment. Chemotherapy and limited field irradiation have improved survival in Hodgkin's disease. Treatment varies widely in neuroblastoma according to stage with disseminated disease still carrying a very poor prognosis. Survival in Wilms' tumour has improved to such an extent that long-term side-effects of therapy now need to be considered.

Antineoplastic Agents↗
PubMed1979

Amelioration of cancer chemotherapy-induced nausea and vomiting by delta-9-tetrahydrocannabinol.

The antinausea and antivomiting effects of delta-9-tetrahydrocannabinol (THC) in children receiving cancer chemotherapy were compared with those of metoclopramide syrup and prochlorperazine tablets in two double-blind studies. THC was found to be a significantly better antinausea and antivomiting agent, but not all patients obtained relief of nausea and vomiting with THC. In some patients, THC enhanced appetite during a course of chemotherapy. In two patients, a "high" associated with THC administrationwas reported. Drowsiness was reported significantly more frequently with THC.

Antiemetics↗
PubMed1979

Poor outlook for childhood acute lymphoblastic leukaemia with relapse.

Results of treatment in 72 children with a relapse of acute lymphoblastic leukaemia were analysed. A second remission was induced in 57 children (79%). Remission rates were significantly higher in males, and in patients with white cell counts less than 30 X 10(9)/L. The median duration of the second remission was only four months, and the median duration of survival from the time of relapse was nine months. The median duration of survival from the time of diagnosis was 27 months. Among children who suffered a relapse was a small group who had prolonged survival and prolonged second remissions. It is uncertain whether some of these may have a chance of "cure".

Child↗
PubMed1979

Treatment of osteosarcoma.

Hippocrates has been credited with the statement 'for extreme diseases, extreme methods of care are most suitable'. This statement is very applicable to the disease osteosarcoma and especially to its treatment with high dose methotrexate. This paper will present the experience of the Department of Clinical Haematology and Oncology in the treatment of osteosarcoma with high dose methotrexate and summarize other groups' experiences with various chemotherapy regimes.

Adolescent↗
PubMed1978

Cytokinetic studies in children with untreated acute lymphocytic leukaemia (ALL): relationship to "T" cell markers.

"The labelling index (LI), mitotic index (MI) of marrow lymphoblasts and the percent of peripheral blood lymphocytes and lymphoblasts that form rosettes with sheep red cells at 4 degrees C ("T4"), were measured at presentation in 33 children with ALL. There was a significant correlation between LI and MI, but no significant correlations between them and the total white cell count at diagnosis or the "T4" percent. Three patients had greater than 55% "T4" rosettes and showed increased LI and MI, and 2 have relapsed; 12 had less than 20% "T4" rosettes, showed an increased LI (LI greater than 8% in 8 of 12) but not MI, and 5 have relapsed; 18 had 20--55% "T4" rosettes and generally had the lowest LI (LI less than 8% in 11 of 18), and only 3 have relapsed. Our findings suggest that patients with high and low percentage of "T4" rosettes in the peripheral blood have an increased fraction of leukaemic cells in DNA synthesis and have a diminished chance of prolonged remission.

Child↗
PubMed1978

Treatment of childhood lymphocytic leukaemia with high white-cell counts.

Combination chemotherapy with cytosine arabinoside, cyclophosphamide and L-asparaginase (Asnase) was given to 22 children with acute lymphocytic leukaemia (ALL) with a white-cell count greater than 30 X 10(9)/1, and other features suggestive of poor prognosis. Complete remission was induced in all patients--in 19 after 2 courses of chemotherapy and in the remainder after a third course. During induction, neutropenia occurred in 18 and severe infection in 3. Anaphylaxis to Asnase occurred in 8 patients after the second course and one other had transient Asnase-induced diabetes. All patients received central-nervous-system prophylaxis after achieving remission, during which they were also treated with weekly vincristine and a 2-week course of prednisolone. Continuation therapy consisted of short cycles of intermittent chemotherapy and BCG inoculation or long cycles of intermittent chemotherapy +/- BCG. Life-table analysis shows 46% complete remission rate at 28 months, with 6 patients all in complete remission followed up between 28 and 41 months. There were minimal complications of continuation therapy, and BCG inoculation was well tolerated.

Adolescent↗
PubMed1978

Hematologic emergencies in children.

Hematologic emergencies may be defined as sudden or unexpected life-threatening events in clinical hematology and oncology which require immediate action predominantly based on clinical judgements and supported only by investigations that can be expected to produce results rapidly. It is convenient to classify these emergencies according to disorders affecting the erythrocytes; leukocytes; platelets; hemostasis; defence mechanisms against infection; the respiratory system; and emergencies related to drugs used for the treatment of neoplasia. A proposed classification is outlined. Part of treatment of hematologic emergencies is to ensure that the cicumstances which caused them will not recur in the same patient or those with similar disorders.

Acute Disease↗