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Biomedical subjects

W A Smithson

Publications and source records attributed to W A Smithson.

67 records · Page 4Linked to original sources
PubMed1979

L-asparaginase used with cytosine arabinoside in treatment of childhood acute lymphocytic leukemia refractory to vincristine and prednisone.

Eleven patients with acute lymphocytic leukemia in relapse were treated with L-asparaginase and cytosine arabinoside (1-beta-D-arabinofuranosylcytosine) in induction therapy and the same drugs plus cyclophosphamide in maintenance therapy. Three patients had complete remissions lasting 6, 16, and 78+ weeks. One patient experienced partial remission and four had decreased bone marrow or peripheral blasts but were not clinically improved. The responses, which were brief, lasted 1-16 weeks with one exception of 78+ weeks. Four patients had allergic reactions to L-asparaginase that were unpredictable with assays of antibodies against L-asparaginase.

Adolescent↗
PubMed1979

Acute lymphoblastic leukemia in children: immunologic, cytochemical, morphologic, and cytogenetic studies in relation to pretreatment risk factors.

Thirty children with previously untreated acute lymphoblastic leukemia were studied prior to therapy to determine whether sheep erythrocyte (E)-receptor status correlated with clinical factors, cytochemical staining characteristics, FAB morphologic classification, and karyotype. Five patients (17%) with more than 50% E+ blasts had intense focal acid phosphatase staining and distinct clinical characteristics, including high leukocyte counts, mediastinal masses, and involvement of the central nervous system at diagnosis. Focal acid phosphatase activity was present in blasts of patients with greater than 20% E+ blasts, but this group had fewer poor risk factors. Morphologic and karyotypic features were not related to erythrocyte-receptor status, but the L2 morphologic appearance occurred more frequently in older patients (P less than 0.05). Erythrocyte receptors have both qualitative and quantitative clinical correlations in childhood acute lymphoblastic leukemia; however, E+ and E- groups are heterogeneous and E+ groups must be analyzed for other risk factors and relapse rates determined before firm conclusions can be made about erythrocyte rosetting as an independent risk variable.

Acid Phosphatase↗
PubMed1978

Extreme leukemic leukocytosis (blast crisis) in childhood.

Children with leukemia who have extremely high leukocyte counts (more than 100,000/mm3) when seen initially are at high risk of early sudden death, usually from massive intracerebral hemorrhage. Nine such patients were seen during a 39-month period. Eight had pronounced adenopathy and hepatosplenomegaly without severe anemia or thrombocytopenia. The first six patients died suddenly. Cerebral perivascular infiltration and increased blood viscosity are the probable pathophysiologic mechanisms. A treatment program was developed, the goal being the early elimination of blast cells. Three consecutive patients patients presenting with leukocyte counts greater than 100,000/mm3 were treated with emergency cranial irradiation, and all three survived to receive systemic chemotherapy.

Acute Disease↗
PubMed1978

Testicular relapse in childhood leukemia.

Five patients in bone marrow remission from childhood leukemia who subsequently had relapse in the testicle are reviewed. Clinically, recurrence of disease is often limited to this site. In spite of satisfactory local control with radiotherapy, further systemic progression generally occurs within 1 year. Previous studies suggest that patients who are in clinical remission harbor tumor in multiple occult "sanctuaries." Testicular leukemia reflects this uncontrolled extramedullary disease, and studies in optimal management of the generalized process are needed.

Child↗
PubMed1978

Acute myelomonocytic leukemia after irradiation and chemotherapy for Ewing's sarcoma.

A case is presented in which the diagnosis of acute myelomonocytic leukemia was made 16 months after the start of irradiation and chemotherapy for Ewing's sarcoma. The association of these two diseases is rare. The etiologic role of therapy in the development of leukemia is speculative in this case. However, there is need for surveillance for secondary neoplasms of all types so that the benefits of therapy may be properly weighed against the risks.

Adolescent↗
PubMedDate not supplied

One course versus two courses of antithymocyte globulin for the treatment of severe aplastic anemia in children.

PURPOSE: The aim of the therapeutic trials was to optimize the treatment of severe aplastic anemia (SAA) and moderate aplastic anemia in children who lack a suitable bone marrow donor, using immunosuppressive therapy in the most effective combination and dose. PATIENTS AND METHODS: Two sequential therapeutic trials for the treatment of severe and moderate aplastic anemia in children were conducted by 10 institutions. The treatment protocols included antithymocyte globulin (ATG), prednisone, and cyclosporine A (CSA); patients entered on the first protocol, 0190 (ATG X 2), were given two courses of ATG, and those enrolled on the second protocol, 0190B (ATG X 1), were given only one course of ATG. Ten patients were evaluable on ATG X 2. All patients had SAA; three had hepatitis-induced severe aplastic anemia (HI-SAA). Twelve patients were evaluable on ATG X 1; all had SAA, one of whom had HI-SAA. RESULTS: Seven of 10 patients on ATG X 2 responded, and eight of 12 patients treated on ATG X 1 responded. CONCLUSION: Treatment with immunosuppressive therapy using ATG, CSA, and prednisone was very well tolerated. The response rates in both protocols were similar, and results compare favorably with those of previous therapeutic trials, suggesting that a second course of ATG is not necessary.

Adolescent↗
PubMedDate not supplied

Severe 6-thioguanine-induced marrow aplasia in a child with acute lymphoblastic leukemia and inherited thiopurine methyltransferase deficiency.

6-thioguanine (6TG) is undergoing investigation for use in the maintenance phase of acute lymphoblastic leukemia (ALL). Just as with 6-mercaptopurine (6MP), it is be expected that 6TG would cause pancytopenia in individuals with inherited thiopurine methyltransferase (TPMT) deficiency. We report the first case of severe and prolonged pancytopenia caused by 6-thioguanine in an 8-year-old boy with ALL and inherited TPMT deficiency. Neutropenia lasted 67 days, whereas anemia and thrombocytopenia did not recover for 96 days. To obviate this life-threatening complication, clinicians should consider assaying TPMT activity before initiating therapy with 6MP and, particularly, 6TG in children with ALL.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

Childhood acute lymphocytic leukemia.

At present, significant numbers of children with ALL enjoy prolonged survival without serious sequelae. All children should be given the benefit of treatment under the supervision of physicians experienced in childhood cancer. Risk factors should be properly assessed and children at high risk placed in innovative programs. Longterm follow-up of patients is essential to detect, as early as possible, potentially prohibitive toxicity.

Antineoplastic Agents↗
PubMedDate not supplied

Phase II study of recombinant alfa-2a interferon in patients with advanced bone sarcomas.

Twenty previously treated patients with advanced bone sarcomas received thrice weekly im 50 X 10(6) IU/m2 doses of human alfa-interferon (interferon alfa-2a, recombinant; Roche). Seventeen patients had metastatic osteosarcomas and one each had fibrosarcoma, mesenchymal chondrosarcoma, and malignant fibrous histiocytoma. Two patients with osteosarcoma and the one with malignant fibrous histiocytoma experienced objective partial tumor regression for 1, 3, and 2 months, respectively. Fever, anorexia, myalgia, fatigue, lethargy, and moderate myelosuppression were observed commonly, and some patients developed mild nausea, vomiting, and diarrhea. No patient withdrew because of toxicity and no dose reductions were necessary except adjustments for changes in body surface area secondary to weight loss.

Bone Neoplasms↗