Platelet count change by vincristine in maintenance phase of acute lymphoblastic leukemia chemotherapy / 소아과

PURPOSE: The hematologic change during the treatment of acute lymphoblastic leukemia(ALL) is critical as a prognostic determinant and a variable to determine the dose of chemotherapeutic agents. It is known that the dose of vincristine used in the maintenance phase of ALL is small enough to increase the count of platelet. To investigate the change of platelet count according to the vincristine administration in maintenance phase of ALL chemotherapy, we performed this study. METHODS: Eleven patients eligible under the criteria of Children's Cancer Study Group(CCG)-1882 and who had completed chemotherapy were enrolled in this study. The count of platelets before vincristine administration was compared with those of vincristine administration 1, 2 and 3 weeks after the early and last periods of maintenance phases. The platelet count before vincristine administration was defined as 100 percent and that after vincristine were compared. In addition, we tentatively defined an enhancing effect of vincristine as positive when the relative count was more than 120 percent. RESULTS: Platelet count did not differ according to the early and last periods of maintenance phase. Platelet count at first week after vincristine administration increased more significantly than that before vincristine in early and last periods. There was an enhancing effect in 10(90.9 percent) of 11 patients after 1 week vincristine administration both in the early and last periods of the maintenance phase. CONCLUSION: Vincristine, used in ALL maintenance phases as a low dose, increased platelet count 1 week after administration. The increased platelet count resumed to the previous level 2-3 weeks later. However, the thrombocytosis observed in the maintenance phase by vincristine was not high enough to induce thrombosis. In addition, vincristine is known to reduce the activity of platelets. Therefore, the risk of thrombosis in the maintenance phase of ALL chemotherapy would be low.

Osteonecrosis following an Intensified Chemotherapy Including High Dose Corticosteroids in Acute Lymphoblastic Leukemia / 대한소아혈액종양학회지

PURPOSE: The use of greatly intensified anticancer drugs enhances the long-term survival of patients with childhood acute lymphoblastic leukemia (ALL). However, the intensified chemotherapy regimen commonly results in increased long-term morbidity. Dexamethasone, which is more potent than prednisone for its antileukemic effects, has been suspected to more vigorously provoke osteonecrosis (ON). We performed this study to investigate the prevalence and clinical features of ON in the high-risk ALL patients who were treated with high dose corticosteroids. METHODS: We investigated ON in 18 patients who had completed high-risk ALL chemotherapy (CCG-1882, regimen A). We compared the ALL patients with ON and the ALL patients without ON for the clinical features of ALL and for the factors that are related to the development of ON. In addition, the clinical features of ON were evaluated. RESULTS: For the entire study group, 3 (16.7%) of 18 patients had ON. The average age at the time of diagnosis of ON was 10.3 years compared with 6.0 years average age for the total enrolled patients. Among the three patients, 1 (33.3%) was male and 2 (66.7%) were female. The average time that passed from the initiation of chemotherapy to the diagnosis of ON was 23.7 months. A total of 7 joints were involved, with an average of 2.3 joints per patient diagnosed with ON. The affected joints were 3 (42.9%) hips and 4 (57.1%) ankles. CONCLUSION: The result of this study was similar to the previous reports. ON, which could be prevented and treated by decreasing the corticosteroid dose and with instituting early orthopedic intervention, is relatively commonly seen in the older children who are treated with high dose corticosteroid for ALL. In this regard, to minimize the risk of ON, newer chemotherapy protocols for older children should be administered with a reduced dose of dexamethasone.

Neonatal Lupus Erythematosus Manifests as Pancytopenia and Mildly Abnormal Liver Functions / 대한주산의학회잡지

Neonatal lupus erythematosus (NLE) is an uncommon passive autoimmune disease in which there is a transplacental passage of anti-Ro or anti-La maternal autoantibodies. The cutaneous lupus lesions are commonly observed and usually resolve spontaneously. The cardiac involvement which sometimes needs the permanent pacemaker, however, is the most clinically significant manifestation of NLE. In addition, the hepatic and hematologic abnormalities are observed in approximately 10% of infants with NLE. Therefore, in the way of the evaluation of hematologic disorders in neonate, NLE should be included. We present a case of NLE in an infant born to a mother with anti-Ro, and he had skin rash, pancytopenia and mildly abnormal liver functions without cardiac manifestation.