ABSTRACT
We evaluated and compared hematologic, hepatic and renal cumulative toxicity of high dose methotrexate (HDMTX) repeated courses in two groups of pediatric patients: 22 patients affected by "non B" acute lymphoblastic leukemia (ALL) treated, in consolidation phase, with four courses of HDMTX 5 g/mq given intravenously over 24 hours infusion (for a total of 88 courses) according to the Italian Cooperative Protocols AIEOP LLA-88; 18 patients affected by non metastatic osteosarcoma of extremities (OST) treated, in preoperative and postoperative phases, with five courses of HDMTX 8 g/mq given intravenously over 6 hours infusion (for a total of 90 courses) according to CNR-NEO 2 protocol. Severe myelosuppression (neutropenia < 500/microliters and/or thrombocytopenia < 25000/microliters) was more frequently observed in ALL (7% of infusions) than in OST (3%). Hepatotoxicity (serum transaminase elevation > 350 IU/l) was significantly more frequent (p < 0.001) in OST (32% of courses) than ALL (6%). Nephrotoxicity was assimilable in the two groups and the elevation of serum creatinine was never higher than 1.9 mg/dl. We did not observe any increase of hematologic, hepatic and renal toxicity following the HDMTX courses repetition.
Subject(s)
Antineoplastic Agents/adverse effects , Bone Neoplasms/drug therapy , Methotrexate/adverse effects , Osteosarcoma/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/pharmacology , Bone Neoplasms/pathology , Child , Dose-Response Relationship, Drug , Humans , Infusions, Intravenous , Kidney/drug effects , Liver/drug effects , Methotrexate/administration & dosage , Methotrexate/pharmacology , Neutropenia/etiology , Osteosarcoma/pathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Thrombocytopenia/etiologyABSTRACT
Age is an important prognostic factor in acute childhood lymphoblastic leukemia (ALL): intermediate age children (1-9 years) show a better outcome than infants (0-1 year) and adolescents (10-15 years). However recent literature data do not agree about adolescents worse prognosis. We tried to contribute to this issue with a retrospective analysis about presenting features and survival of 302 pediatric patients (65 adolescents and 237 children) with non B ALL enrolled on AIEOP protocols at the Departments of Pediatric Haematology-Oncology (University of Turin) from 1976 to 1992. The last follow up was 30.11.94. We found in adolescents, in spite of higher frequency of unfavourable prognostic factors (Hb > 8 g/dl, mediastinal mass, T cell immunophenotype, L2 morphology), an event free survival similar to children (EFS 52% vs 51%). In conclusion in our population we found that age at diagnosis greater than 10 years does not represent an unfavorable prognostic factor.
Subject(s)
Adolescent , Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology , Age Factors , Child , Child, Preschool , Cytogenetics , Female , Humans , Incidence , Infant , Italy/epidemiology , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Retrospective Studies , Sex FactorsABSTRACT
The paper describes four cases of trisomy 18 or Edwards' syndrome observed in the Pediatric Division of SS. Annunziata Hospital, Savigliano (CN) between 1/1/79 and 31/12/88. Following an illustrated description of the cases (3 males and 1 female), the epidemiological and clinical aspects of the syndrome are briefly discussed.