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Biomedical subjects

U Creutzig

Publications and source records attributed to U Creutzig.

At least 91 records · Page 5Linked to original sources
PubMed1987

Effective remission induction in children with recurrent acute myeloid leukemia by mAMSA, Ara-C, and VP 16.

Five children treated for acute myeloid leukemia according to the BFM protocol AML 83 experienced first bone marrow relapse after 7, 10, 14, 18, and 30 months and were retreated for second remission induction. The chemotherapy consisted of mAMSA (100 mg/m2 per day i.v., days 1-3), ARA-C (100 mg/m2, twice daily, days 1-6), and VP 16 (150 mg/m2 per day, days 4-6). Four of the children achieved a complete second remission after one course of chemotherapy, and the fifth child died of pneumonia during bone marrow aplasia. All surviving children received an identical second course within 4-5 weeks, followed by maintenance chemotherapy. Remission duration was 0, 3, 4, 5, and 5 months. Toxicity was confined to heavy bone marrow depression with thrombocytopenia (nadir 2-7000, days 7-13) and leukocytopenia (nadir 0-400, days 8-14). Bleeding episodes could be prevented by substitution with platelets. Four patients experienced infections (pneumonia, septicemia). We conclude that combination chemotherapy using mAMSA, ARA-C, and VP 16 is effective in inducing a second remission in patients with early bone marrow relapse. The main side effect was considerable bone marrow toxicity.

Amsacrine↗
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↗
PubMed1987

Myelodysplastic syndromes in childhood. Report of 21 patients from Italy and West Germany.

Nine Italian and 12 German children fulfilled the criteria of myelodysplastic syndromes (MDS), according to the French-American-British (FAB) classification. All patients belonged to the more aggressive subtypes of myelodysplastic syndromes. Four presented with refractory anemia with excess of blasts (RAEB), 16 presented with refractory anemia with excess of blasts in transformation (RAEB-T), and 1 had chronic myelomonocytic leukemia (CMML). Dyserythropoiesis and dysgranulopoiesis were seen in all patients, and dysmegakaryopoiesis was seen in most patients. Cytogenetic studies in 13 of the 21 children showed karyotype abnormalities in 8; 5 had monosomy 7. Eleven patients were treated with intensive chemotherapy soon after diagnosis; 6 achieved complete remission (CR), and 2 of them are alive and still in complete remission after 48 and 69 months. Low-dose cytosine arabinoside (Ara-C) was given in six children without improvement. Bone marrow transplantation after progression of the disease has produced complete remission lasting 28 + months now in one of two patients. Four patients received only symptomatic treatment. The rate of 5-year survival for the total group was 20% (SD 9%). We conclude that children with MDS may benefit from more aggressive treatment, but that in general the survival rate is poor and similar to that observed in adults with the same subtypes of this disease.

Adolescent↗
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↗
PubMed1985

Treatment of acute myelogenous leukemia in children.

Progress in the treatment of childhood AML has not equalled the advances obtained in the management of ALL. Two recent chemotherapy studies (i.e. VAPA and BFM 78), however, reported marked increase in the proportion of long-term remissions. The initial therapy of the cooperative study BFM 78 consisted of two 4-week phases of intensive induction/consolidation with 7 different drugs and cranial irradiation followed by maintenance with thioguanine and cytosine arabinoside for 2 years and additional adriamycin during the first year. A total of 151 children with AML were enrolled in the study from 30 centers. Of these 119 (79%) patients achieved complete remission. After a median observation time of 34 (14-57) months, there have been 46 relapses. CNS was involved in 6 of these relapses. Life table analyses revealed the following probabilities after 4 1/2 years: survival: 46%; disease-free survival: 41% (total group), 52% (remission group); disease-free interval 56% (remission group). The risk of relapse appears to decrease considerably after 2 1/2 years. No risk factors for the occurrence of relapse have been identified.

Adolescent↗
PubMed1985

Improved treatment results in childhood acute myelogenous leukemia: a report of the German cooperative study AML-BFM-78.

One hundred fifty-one children with acute myelogenous leukemia (AML) entered the cooperative study BFM-78 between December 1978 and October 1982. The initial therapy consisted of an intensive induction and consolidation regimen over eight weeks with seven different drugs and cranial irradiation. It was followed by maintenance with thioguanine and cytosine arabinoside for two years and additional Adriamycin during the first year. One hundred nineteen (79%) patients achieved a complete remission. Thirteen (9%) children died of early hemorrhages. After a median follow-up time of 36 (12 to 57) months, 47 relapses have occurred, with CNS involvement in seven cases. The life table analysis revealed a probability for overall survival after almost five years of 45% (SD, 4%), for event-free survival 41% (SD, 4%), and for the event-free interval 52% (SD, 5%). Up to now, no relapse was seen after 2 1/2 years. Risk factor analysis showed that early fatal hemorrhages occurred predominantly in children with M5 FAB type and with initial leukocytosis. An initial high WBC count and liver enlargement were unfavorable parameters for achieving remission. No factors could be identified concerning the risk for relapse. These data indicate that the applied treatment strategy is successful in inducing complete remissions in about three fourths of children with AML and also in enhancing considerably the chances for long-term remission.

Adolescent↗
PubMed1981

[Acute leukemia in a 13-year old boy with a synchronous occurrence of lympho- and monoblasts (author's transl)].

The synchronous occurrence of blasts of the lymphatic and myelogenous lineage in acute leukemia has been rarely observed. Reviewing individual case reports it is suggested that malignant transformation already starts at the level of the stem cell. We are reporting a case of a 13-year old boy who initially showed morphological features of acute lymphatic leukemia. Following 14 days of therapy the assumption of a pure lymphatic lineage has to be changed in favour for monoblasts which are now occurring.

Acute Disease↗
PubMed1980

[Treatment of relapse in acute lymphoblastic leukaemia of childhood (author's transl)].

Intensive chemotherapy according to the West Berlin protocol was given in 15 children with acute lymphoblastic leukaemia with bone marrow recurrence after an initial remission period of 12 months or longer. Treatment of first episode had followed the 1971 recommendation of the German working group for research and treatment of childhood leukaemia (Memphis VII protocol). One child died from Pseudomonas septicaemia during relapse treatment, the other 14 achieved renewed complete remission for 4 to 50 months. All 5 children in whom the initial remission had lasted less than 20 months had another recurrence after 12 to 17 months. Four out of the 9 patients with an initial remission period of 20 months or longer had another bone marrow relapse after 5 to 36 months. Five children are in continuing second remission for 26 to 50 months, 4 of them already off treatment (for the last 5 to 12 months). The results show that in certain cases of relapse of acute lymphoblastic leukaemia of childhood a new chance of long-term remission and perhaps cure exists, particularly after long initial remission, when a suitable intensive treatment regime is followed.

Bone Marrow↗
PubMedDate not supplied

Toxicity and effectiveness of high-dose idarubicin during AML induction therapy: results of a pilot study in children.

BACKGROUND: Idarubicin (IDR) is one of the most effective, but also toxic drugs in the treatment of AML. The standard dose used in children and adults is 8-12 mg/m2 during induction. PATIENTS AND METHODS: To improve outcome, we increased the IDR dose from 12 mg/m2 (standard dose in study AML-BFM 93), applied over three days during induction therapy (AIE = Ara-C, Idarubicin, Etoposide) to 14 mg/m2 in a pilot study including 17 patients (16 with de novo AML, one with secondary AML). Outcome and toxicities were compared with the other patients of study AML-BFM 93, treated with 3 x 12 mg/m2 IDR or 6 x 30 mg/m2 daunorubicin (DNR). RESULTS: Patients of the pilot study achieved a good blast cell reduction in the bone marrow on day 15, a high CR rate of 94% and a low relapse rate (3/17 pts.), however, not significantly different to the IDR (12 mg/m2) group. Hematological toxicity was high, median duration until neutrophil recovery > 500/microliter was 25.0 (12-66) days, and similar to the IDR (12 mg/m2) and DNR groups. Duration of thrombocytopenia (time to > 20,000/microliter) was 21 (10-66) days in the pilot study compared to 19 (7-26) days in DNR patients (p = 0.08). Four of 17 pilot patients presented with severe WHO grades 3/4 of mucositis during induction. One patient died in long-lasting aplasia after the 3rd treatment block. CONCLUSION: Results of this pilot study show that the IDR 14 mg/m2 regimen was effective but also toxic. According to our results which, however, are based on small patient numbers, an improved outcome compared to the IDR 12 mg/m2 regimen seems to be unlikely, therefore the possibly increased toxicity might not be acceptable.

Acute Disease↗