Childhood stage IV Hodgkin disease: therapeutic results of the Polish pediatric leukemia/lymphoma study group.

BACKGROUND: The therapeutic management in patients with stage IV Hodgkin disease is still controversial. PROCEDURE: Among 783 children with Hodgkin disease treated from 1971 to 1996, 56 patients (7.3%) were diagnosed with stage IV. The treatment consisted of MVPP or MVPP/B-DOPA chemotherapy combined with involved-field radiotherapy in 50 children. RESULTS: The results of treatment of stage IV patients were compared in the three sequential time periods, during which the therapy was modified. In these periods, the first complete remission was obtained in 67%, 86%, and 90% of children, respectively, and the 10-year event-free survival was 42%, 64%, and 85%, respectively. CONCLUSIONS: Alternate multidrug chemotherapy combined with low-dose involved-field radiotherapy is at present a satisfactory therapeutic method in children with stage IV Hodgkin disease.

[Does residual mediastinal mass in children with completed treatment of Hodgkin's disease affect the incidence of relapses?]. / Czy resztkowy guz sródpiersia przetrwaly po zakonczeniu leczenia choroby Hodgkina u dzieci ma wplyw na czestosc wystepowania wznów?

Four hundred and four children with Hodgkin's disease (stage I-IV) were treated in seven cooperating centers of Polish Paediatric Leukaemia/Lymphoma Study Group between 1988 and 1996. Mediastinal masses and/or hilar involvement were found in 261 (65%) patients. Remission was obtained in 256 (98%) of this group. In 31 (12%) children residual mediastinal/hilar masses were found after completing the treatment. For this reason in 13 cases the number of chemotherapy courses and/or the dose of radiation therapy were increased. In two cases thoracotomy or thoracoscopy were performed, and in one case gallium scan was performed. In none of these patients active disease was found. Relapses occurred in 4 (12.9%) from the group of 31 children with residual mediastinal/hilar involvement 8-15 months after cessation of the therapy. Twenty seven children have been in first remission for 5-113 months (median, 34). In 225 patients with a complete resolution of their mediastinal/hilar masses, relapses occurred in 13 (5.7%) cases. Patients with residual mediastinal mass should be carefully evaluated before making a decision to complete their treatment, including CT scan, MRI, and gallium scan. In doubtful cases histopathological verification should be done.

[Results of treatment for severe acquired aplastic anemia in children]. / Wyniki leczenia ciezkiej, nabytej niedokrwistosci aplastycznej u dzieci.

The authors evaluated results of treatment of 106 children with acquired aplastic anemia. The patients were divided into 3 groups depending on the severity of their disease. Thirty-nine patients were classified as very severe, 30 as severe and 37 as non-severe according to the modified Camitta criteria. Among them, 47 children were treated with oxymetholone and prednisolone. In this group 32 died. Antilymphocyte globulin (ALG) was given to 48 patients and 20 received cyclosporin A (CsA). The results obtained by these two methods are nearly the same and 5 year survival was 61% and 59% respectively. Bone marrow was transplanted in only one child, who is still in complete remission. Statistical analysis showed a steady increase in incidence of aplastic anemia in the years 1987-1989, which might coincide with the Czarnobyl explosion. However, further research is required to prove this point.

[Transient diabetes mellitus with ketoacidosis in a child during the treatment of acute lymphoblastic leukemia with L-asparaginase]. / Przejsciowa cukrzyca z kwasica ketonowa w przebiegu stosowania L-asparaginazy u dziecka z ostra bialaczka limfoblastyczna.

A case of a 11-year girl with the acute lymphoblastic leukemia is presented. Patient was treated with L-asparaginase and developed a transient but lasting several weeks diabetes mellitus with ketoacidosis as a sequelae of this therapy.

[Detection of the foci of familial toxoplasmosis in rural environment]. / Poszukiwanie ognisk toksoplazmozy rodzinnej w srodowisku wiejskim.

In order to detect centres of family toxoplasmosis in rural environment 24,546 patients, suspected of invasion of T. gondii, 504 healthy persons coming from villages and 1,681 live stock were examined. Among persons suspected of infection of T. gondii, 65 cases of congenital family toxoplasmosis and 19 cases of environment family toxoplasmosis, involving several members of the family were detected. In animals a comparatively high percentage with positive reaction in the direct agglutination test (cattle 55.5%, swine 27.9%, sheep 23.4%) was detected. The following serological tests were applied to humans: complement-binding test (OWD), indirect immunofluorescence test (OIF), direct agglutination test with 2-mercaptoethanol (CA), ELISA IgM and, selectively, immunoperoxidase test IgM (OIP). The results suggest that the environment conditions can play an important role in the occurrence of family toxoplasmosis in our country, especially in the countryside. Detecting active toxoplasmosis in a family member should be a signal to start serological-epidemiological examination of the remaining family members and live stock.