Study of tolerance and effectiveness of a varicella vaccine in leukemic children.

Chickenpox could be a severe disease in immunocompromised patients. Live attenuated vaccine is now available. We conducted a trial in 37 leukemic children with OKA varicella vaccine. Full immunization was observed in all 20 seronegative patients. Few side effects and no generalized vaccinal infection were observed. Further studies are warranted to assess the benefit of vaccination in leukemic patients considering the effectiveness of Varicella Zoster Immuno-Globulins and Aciclovir.

[Treatment of autoimmune hemolytic anemias in children]. / Traitement des anémies hémolytiques auto-immunes de l'enfant.

Management of autoimmune hemolytic anemias (AIHA) in children is often difficult as some patients are very young and the course is often unpredictable. Corticosteroid therapy is the mainstay of the treatment of AIHAs. A dose of 2mg/kg/d should be given as early as possible. The return to normal of hemoglobin levels and reticulocyte counts are the two chief criteria of effectiveness. Only when both are present can disease remission be affirmed and corticosteroid therapy phased out over several months. Inadequate therapy of an acute form may promote prolongation of the disease. Prior to blood transfusion, the following tests should be performed: determination of ABO and Rh groups, determination of the erythrocyte phenotype whenever possible, identification of the specificity of the autoantibody, and investigations for an alloantibody. Splenectomy and immunosuppressive treatments are very rarely used and are indicated only in chronic forms of more than three months duration that fail to respond to high dose corticosteroid therapy or relapse as soon as doses are reduced. On the opposite, some forms are hyperacute and resolve very rapidly, with negativation of the often complement-type Coombs test; the course may be self-limited, especially if the autoantibody is a cold agglutinin or a biphasic hemolysin (Donath Landsteiner type), requiring no more than a few weeks of corticosteroid treatment.

[Ceftazidime for the treatment of infections in neutropenic children]. / La ceftazidime pour le traitement des infections chez l'enfant neutropénique.

Ceftazidime in doses of 100 mg/kg/day was used, combined with netilmicin 6 mg/kg/day, as first-line treatment in two successive studies conducted on febrile neutropenic children (neutrophils less than 500/mm3). Study n. 1, performed at the Infantile Haematology unit of Saint Louis hospital, Paris, included 75 children. Study n. 2 was a multicentre study involving 88 children from 11 medical centres. The children's age in both studies ranged from 2 months to 16 1/2 years (mean 7 years). The percentage of bacteriologically documented febrile episodes was 45 per cent (34/75 and 39/88), and the most frequent infections were those caused by Gram-positive cocci (56 and 58 per cent respectively of the cases). Vancomycin 40 mg/kg/day was introduced if fever was still present 48 hours after the beginning of the antibiotic therapy. Effective treatments were continued until the neutropenia was corrected. These children were being treated for acute leukaemia, lymphoma, solid tumours or bone marrow aplasia. In study n. 1 apyrexia was obtained in 85 per cent of the cases with the ceftazidime-netilmicin combination and in 91 per cent of the cases after addition of vancomycin. The initial therapy was effective in all patients with a documented infection. There were tow super-infections with septicaemia: one due to Streptococcus D, the other to Staph. epidermidis. In study n. 2 73 per cent of the patients were apyretic after the first combination and 85 per cent after vancomycin was introduced. In proven infections the ceftazidime-netilmicin combination was effective in 30 cases and in another 6 cases after addition of vancomycin. Three patients remained febrile until they came out of aplasia. In all cases the bacterial cultures were sterilized by the ceftazidime-netilmicin combination. There was no superinfection. The mean duration of antibiotic therapy was 21 days in study n. 1 and 14 days in study n. 2. The drugs were perfectly tolerated both clinically and biochemically. No death occurred in the two studies. Thus, owing to its broad spectrum, effectiveness and safety ceftazidime is a very useful antibiotic when combined with netilmicin as first-line treatment of febrile neutropenic children.

[Importance of anthracyclines in infants in the treatment of acute lymphoblastic and non-lymphoblastic leukemias]. / Intérêt des anthracyclines chez l'enfant dans le traitement des leucémies aiguës lymphoblastiques et non lymphoblastiques.

Induction treatment of acute non lymphoblastic leukemia in children and in adults must include anthracyclines, but the best anthracycline is still in discussion. In acute lymphoblastic leukemia the use of anthracycline is discussed according to the initial prognostic factors: needful in high risk patients, useless in good risk. In intermediate risk patient, most cooperative protocols include one anthracycline in induction.

[Induction therapy of acute leukemia in children. Current results and problems related to therapeutic aplasia. Apropos of 146 cases]. / Traitement d'induction des leucémies aiguës de l'enfant. Résultats actuels et problèmes liés à l'aplasie thérapeutique. A propos de 146 observations.

Between 1983 and 1984, 146 children have been treated in the pediatric hematology department of Saint-Louis Hospital (Paris) for induction of acute leukemia (AL). 119 had an acute lymphocytic leukemia (ALL) and 27 an acute non lymphocytic leukemia (ANLL). The rate of complete remission was 94% for all patients (97% in ALL and 81.5% in ANLL). Fever occurred in 95% of children with positive blood cultures in one third on these. Four children died between the fifth and the twenty fifth days after onset of treatment from sepsis. One of these patients was a neonate with ANLL. 127 patients had a central venous line during induction used for blood sampling and treatment (chemotherapy, antibiotics, parenteral nutrition, platelets and red blood cells infusions). This supportive care is very important to improve prognosis of the AL particularly in very intensive chemotherapy.

Acute lymphoblastic leukemia in very young children. Diagnostic and therapeutic aspects of 43 cases.

Between 1974 and 1982, 43 children less than 2 years of age were treated in the hematology department of Hospital Saint-Louis for acute lymphoblastic leukemia (ALL). Of the patients who presented before 18 months of age, 80% had a WBC greater than 100,000 microliter and/or a great tumor bulk. As a result of our experience, treatment regimens have been changed here from conventional chemotherapy to a very intensive program with a heavy induction (vincristine, daunorubicin, cyclophosphamide, prednisone, and L-asparaginase) and monthly reinductions with the same drugs plus ArA-C, without maintenance. Prophylaxis included CNS irradiation (16-24 Gy) after 12 months of age, plus intrathecal methotrexate. Complete remission (CR) occurred in 78% before 18 months and in 100% between 18 and 24 months of age at diagnosis. In this report the probability of a prolonged CR (33% at 2 years) was the same before and after 12 months of age. However, younger patients were more intensively treated. The prognosis for children less than 1 year of age who received very intensive chemotherapy has greatly improved, with a significantly higher probability of long CR (p less than 0.02). Presently, 10 of 43 children are in CR 27 months to 8 years after diagnosis. Of 18 patients aged less than 1 year at diagnosis, four are in CR. No relapse occurred after 23 months. None of these patients presented with important sequellae, with the exception of one child who suffered from severe bacterial meningitis. An aggressive chemotherapy program is indicated in patients less than 2 years of age. The feasibility of this mode of treatment in young patients is possible only with the help of specific supportive care.

Phase I study of bisantrene in acute nonlymphoblastic leukemia.

A phase I study of bisantrene using a daily injection for 5 days was undertaken in adult patients with relapsing acute nonlymphoblastic leukemia. Seventeen patients received 27 courses, with daily doses ranging from 75 to 250 mg/m2. Although gastrointestinal toxicity and alopecia were rare, hematological toxicity occurred in 85% of the patients. There was cholestasis unrelated to infectious events in 27% of the courses, as well as reversible renal failure in eight of 27 evaluable courses. Responses (complete + partial) were obtained in 35% +/- 10% of the patients. The recommended dose for phase II study is 200 mg/m2/day X 7.