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Biomedical subjects

S B Murphy

Publications and source records attributed to S B Murphy.

At least 55 records · Page 3Linked to original sources
PubMed1995

Ifosfamide/carboplatin/etoposide (ICE) for recurrent malignant solid tumors of childhood: a Pediatric Oncology Group Phase I/II study.

PURPOSE: The combination of ifosfamide (I) and etoposide (E) was useful in salvaging patients with recurrent/resistant malignant solid tumors of childhood. Carboplatin (C), active against a number of pediatric cancers, was added to I and E to form a three-drug combination called ICE to improve the response rate. PATIENTS AND METHODS: ICE, consisting of I 1.5 g/m2 plus E 100 mg/m2 i.v.q.d. x 3 plus C i.v. on day 3 only, was given in 21-28-day intervals. C was started at 300 mg/m2, and the dose was escalated in 25% increments, with three evaluable patients treated at each level. RESULTS: Ninety-two patients were enrolled in this phase I/II study between July 1990 and April 1993. A total of 331 courses of ICE was administered. Median courses of ICE received were three (range, 1-16). The maximum tolerated dose (MTD) for C when used in combination was found to be 635 mg/m2. The response rate for ICE at the MTD for C was complete response (CR) 26% and CR + partial response (PR) 53%. The response was even better in those who received C at the MTD: 32% achieving a CR and 63% a CR + PR. Pancytopenia was the dose-limiting toxicity. Thirteen episodes of bacterial infection were reported, none fatal. Only one patient developed a Fanconi-like syndrome. CONCLUSION: The MTD of C when used with I and E was found to be 635 mg/m2. The overall CR + PR rate for all patients treated at all C dose levels was 53%. Best responses were seen in non-Hodgkin's lymphoma, neuroblastoma, soft tissue sarcomas, and Wilms' tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

B-cell lineage confers a favorable outcome among children and adolescents with large-cell lymphoma: a Pediatric Oncology Group study.

PURPOSE: The goal of this study was to assess the immunophenotype of uniformly treated cases of pediatric large-cell non-Hodgkin's lymphoma (NHL) to determine the prognostic importance of B-cell and T-cell lineages and of CD30 positivity. PATIENTS AND METHODS: Sixty-nine patients were analyzed by immunochemistry. All patients were classified histologically, staged in a uniform manner, and treated according to one of two protocols for localized (stage I and II) NHL or advanced (stage III and IV) large-cell NHL. Antibodies included anti-CD45, CD20, CD45Ra, MB-2 (not clustered), CD3, CD45Ro, CD43, CD15, CD30, and CD68. Statistical analysis used the exact conditional chi 2 and Kruskall-Wallace tests for clinical features and the log-rank test to evaluate event-free survival (EFS). RESULTS: Immunophenotypic results demonstrated 25 B-cell, 23 T-cell, and 21 indeterminate lineage. Twenty-seven patients expressed CD30 (17 T-cell and 10 indeterminate lineage), and of these, 22 showed histology of anaplastic large-cell lymphoma (ALCL). B-cell patients were older (P = .018) and showed more favorable survival than patients with T-cell or indeterminate lineage (96% EFS at 3 years, 96% v 67% and 74%, B v T and indeterminate lineage [P = .027]). B-cell lineage was seen more frequently in limited-stage patients, but was also associated with favorable survival when stratified for stage (P = .036). CD30 expression (P = .96) and ALCL histology (P = .90) did not show significant associations with survival. CONCLUSION: We conclude that among pediatric large-cell lymphomas, B-cell lineage is proportionately less frequent than in adults and CD30 antigen-expressing lymphomas are frequent among patients with T-cell and indeterminate lineage. B-cell phenotype tends to occur in older children and is associated with superior survival.

Adolescent↗
PubMed1995

The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome.

To help to determine the natural history of residual dysplasia of the hip after skeletal maturity, we followed the status of the contralateral hip in 286 patients who had had a total hip replacement for osteoarthrosis secondary to dysplasia. The initial radiographic findings in seventy-four patients in whom advanced osteoarthrosis later developed in the contralateral hip were compared with those in forty-three patients who had reached the age of sixty-five years without having had severe osteoarthrosis. No patient in whom the hip functioned well until the age of sixty-five years had had a center-edge angle of less than 16 degrees, an acetabular index of depth to width of less than 38 per cent, an acetabular index of the weight-bearing zone of more than 15 degrees, uncovering of the femoral head of more than 31 per cent, or an acetabulum in which the most proximal point of the dome had been at the lateral edge (zero peak-to-edge distance).

Adult↗
PubMed1995

Clinical and prognostic significance of chromosomal abnormalities in childhood acute myeloid leukemia de novo.

We report on the chromosomal pattern of 120 patients with childhood AML de novo. One hundred and fifteen patients (96%) had adequate samples for analysis; 98 (85%) of these showed clonal karyotypic abnormalities. They were classified into cytogenetic subgroups which were closely correlated with FAB subtypes: t(8;21) and M2 (n = 9); t(15;17) and M3 (n = 12); inv(16) and M4Eo (n = 9); t(9;11) and M5a (n = 10); t(11q23) other than t(9;11) and M4-M5 (n = 11); and t(1;22) and M7 (n = 4). In patients with -7/del(7q) (n = 6), leukemia was preceded by MDS in half of the cases, although they had diverse FAB subtypes. Thirty-seven patients had miscellaneous abnormalities. Despite a high CR rate, patients with t(8;21) had a very poor survival: only one child was event-free at 3 years from diagnosis. One third of patients with t(15;17) died during induction. Those eight who achieved CR fared well: only two relapsed, and six were event-free survivors. Patients with inv(16) had a high remission rate and a long survival: five children were in CR 20 to 136 months. Both groups with t(9;11) and t(11q23) had a high remission rate: however, outcome was superior for the t(9;11) group when compared to either the t(11q23) group (EFS at 3 years +/- SE, 56 +/- 17% vs. 11 +/- 10%, p = 0.07) or to the remaining patients (p = 0.06). Both -7/del(7q) and t(1;22) groups had low CR rates (50%) and poor survival. Cytogenetic analysis identifies clinically distinct subsets of childhood AML and is useful in tailoring treatment for these patients. Favorable cytogenetic groups (t(15;17), inv(16), and t(9;11)) may do well with current therapy protocols, whereas unfavorable groups (t(11q23), t(8;21), -7/del(7q), and t(1;22)) require more effective therapies.

Child↗
PubMed1994

Pediatric lymphomas: recent advances and commentary on Ki-1-positive anaplastic large-cell lymphomas of childhood.

The importance of staging and classification of pediatric lymphomas is underscored by modern results of clinical trials from many centers and multi-institutional cooperative groups worldwide. Increasing sophistication in immunopathologic classification of the high-grade, aggressive non-Hodgkin's lymphomas (NHLs) characteristic of childhood and adolescence has clarified recognition of a new clinicopathologic entity with predilection for the young, i.e., Ki-1-positive (CD30-positive) anaplastic large-cell lymphoma (ALCL) which accounts for approximately 8-12% of all pediatric NHLs. Even though the majority of ALCLs present with nonlocalized advanced stage (III or IV) disease at diagnosis, five-year survival is in the range of 75-85% from seven reported series of pediatric patients treated with modern multidrug therapy. Further study of this comparatively uncommon entity is needed.

Child↗
PubMed1994

Primary cutaneous Hodgkin's disease. Unique clinical, morphologic, and immunophenotypic findings.

The authors studied five patients with primary cutaneous Hodgkin's disease (PCHD). Each patient presented with skin lesions without evidence of systemic HD. Skin lesions were papules or nodules, many of which regressed spontaneously. Lesions were distinguished from lymphomatoid papulosis (LyP) by the presence of numerous diagnostic Reed-Sternberg (RS) cells that expressed CD30 and CD15 but were negative for CD45R; LyP lesions usually are CD15-, CD45R+. Anaplastic large cell lymphoma (ALCL) was excluded by the polymorphous background of inflammatory cells in PCHD. Three patients with PCHD had a benign course without systemic disease with up to 20 years of follow-up, whereas two other patients developed mixed-cellularity HD in lymph nodes 2 months and 6 years following the onset of PCHD. This study indicates that PCHD does occur as a rare but distinct clinicopathologic entity morphologically and immunophenotypically indistinguishable from nodal HD but with an unexpectedly indolent course in some patients. Patients with PCHD should be observed for development of systemic HD, but unlike patients with LyP or ALCL, an association of PCHD with mycosis fungoides or cutaneous T-cell lymphoma has not yet been observed.

Adolescent↗
PubMed1994

Tibial osteotomy for genu varum. Indications, preoperative planning, and technique.

Valgus osteotomy of the proximal tibia remains the treatment of choice for the young active patient with a progressively symptomatic varus knee and mild to moderate secondary osteoarthritis. Although the natural history of the varus knee is not well established, it is widely accepted that patients with varus malalignment who develop meniscal injuries or progressive cartilage wear will inevitably develop more severe medial compartment osteoarthritis unless the abnormal mechanics of the knee are corrected.

Bone Malalignment↗
PubMed1993

Testicular angiocentric lymphoma of postthymic T-cell type in a child with T-cell acute lymphoblastic leukemia in remission.

BACKGROUND: Angiocentric lymphoma developed in a 6.5-year-old boy with acute lymphoblastic leukemia of thymic origin in remission. He presented with unilateral testicular enlargement 17 months after diagnosis. METHODS AND RESULTS: Biopsy of the testis revealed an angiocentric, angiodestructive polymorphous cellular infiltrate accompanied by necrosis. The lymphoid component showed a mature T-cell immunophenotype (positive for CD2, CD3, CD5, CD7, CD4, CD8). CONCLUSIONS: Angiocentric lymphoma is a rare entity included in the spectrum of angiocentric immunoproliferative lesions, which preferentially involves extranodal sites. Although four cases of angiocentric immunoproliferative lesions have been reported in pediatric patients with acute lymphoblastic leukemia, this is the first reported occurrence of testicular involvement.

Cell Nucleus↗
PubMed1992

Phase I study of recombinant human interferon gamma in children with relapsed acute leukemia.

Fourteen children (ages 2-15 years) with acute leukemia in relapse were treated with daily recombinant interferon gamma for 14 days by subcutaneous injections at fixed dose levels of 0.1, 0.25, 0.5, or 0.75 mg/m2 (1.0, 2.5, 5.0, or 7.5 x 10(6) units/m2) without intrapatient escalation. Patients received a second 14-day course of therapy followed by thrice weekly administration unless there were signs of progressive disease or grade 3 or 4 toxicity. Side effects in the 13 evaluable patients included fever (n = 10), fatigue (9), decreased Karnofsky performance score (8), hypertriglyceridemia (8), myalgia (5), weight loss > 5% (4), elevated liver transaminases (4), and abdominal pain (3). There was only one grade 4 toxicity: one of the six patients at the 0.5 mg/m2 dose level developed reversible acute renal failure. One patient died of gastrointestinal hemorrhage due to disease-related refractory thrombocytopenia. One child had an oncolytic response and two others stable disease for 138 and 148 days. An appropriate dose level for phase II studies in children is 0.5 mg/m2 per day.

Adolescent↗
PubMed1992

Osteotomies of the hip in the prevention and treatment of osteoarthritis.

Osteoarthritis of the hip is common in our society, even in the relatively young patient. Most of this osteoarthritis is mechanical in etiology and is secondary to residual deformity from developmental hip disease. This type of osteoarthritis can often be predicted and prevented if the causative excessive joint pressures are reduced in a timely fashion by corrective osteotomy. Realigning pelvic or intertrochanteric osteotomy of this preventive type is termed reconstructive; those osteotomies performed after osteoarthritis is established are termed salvage. Corrective osteotomy will be clinically successful only if the mechanical etiology for the potential or established osteoarthritis is clear and if the osteotomy succeeds in reducing the pathologically excessive joint loads. The clinical success of osteotomy also requires precise technical planning preoperatively and careful operative technique.

Adolescent↗
PubMed1992

Childhood malignant non-Hodgkin lymphomas of uncommon histology.

Uncommon histologies were identified in 36 of 1336 cases (2.7%) of newly diagnosed childhood non-Hodgkin lymphoma (NHL). Seventeen cases were classified as follicular (six cases as mixed small and large cell, nine as large cell, and two as small non-cleaved cell) and 19 cases as diffuse (18 cases as mixed small and large cell, and one as small cell lymphocytic). The follicular pattern group included a preponderance of male patients; the median age at diagnosis was 11.7 years. These children presented primarily with low-stage disease involving lymph nodes or tonsils. All patients except one achieved complete remission and remain disease-free for 11 months to 18.8 years (actuarial 5-year event-free survival, 94%). The group with diffuse histologies was similar in sex ratio, age at diagnosis (median = 12.1 years), and nodal involvement, but tended to have more advanced-stage disease. Moreover, only 14 of 19 (74%) children with diffuse intermediate-grade histologies are alive in continuous complete remission (actuarial 5-year event-free survival, 70%). These results suggest that follicular pattern childhood NHL has an excellent prognosis, whereas cases with diffuse intermediate-grade histology are prognostically similar to those with diffuse high-grade histologies.

Adolescent↗
PubMed1992

Use of computed tomographic reconstruction in planning osteotomies of the hip.

Certain deformities of the hip joint seem to predispose the hip to the development of osteoarthrosis. Successful surgical correction of these deformities before the onset of osteoarthrosis requires accurate characterization of the anatomic deviations from normal as the first step in planning corrective osteotomy. Three-dimensional computed tomography (CT) reconstruction in planning reconstructive hip osteotomy has most often been employed in developmental dysplasia of the hip. Computed tomography scanning with three-dimensional reconstruction can characterize the often complex deviations from normal in shape and attitude of acetabulum and femoral head in cases with residual hip dysplasia. Three-dimensional reconstruction also allows simulation of redirectional femoral or pelvic osteotomies to facilitate precise application of newer powerful surgical techniques for reorienting the acetabulum.

Adolescent↗