Management of children with isolated testicular leukemia.

Since 1975, nine children with testicular leukemia were treated at the University of Kansas Medical Center on a standard protocol. Six patients presented with overt testicular leukemia and three patients had microscopic testicular leukemia detected on a biopsy done after 3 years of continuous complete remission. All patients had an M1 bone marrow at the time of testicular relapse and one patient had a concomitant central nervous system (CNS) relapse. Therapy consisted of testicular irradiation, CNS chemoprophylaxis, and systemic reinduction chemotherapy. Systemic maintenance therapy after the testicular relapse consisted of 6-mercaptopurine and methotrexate with vincristine/prednisone pulses administered in the same basic dose and schedule as the patient's original maintenance regimen. These nine patients had a mean duration of first remission of 33 months and a mean duration of second remission of 45+ months. Four patients have relapsed (two bone marrow, one CNS, one CNS + bone marrow), but five patients remain in their second complete remission for 33+ to 94+ months from the time of testicular relapse. These results demonstrate that, in some children, testicular leukemia represents a site of temporary drug resistance and long-term second remissions can be obtained (once local disease is controlled) by using the initial maintenance chemotherapy regimen.

Vindesine and prednisone for remission induction in children with acute lymphocytic leukemia.

Vinca alkaloids are effective anticancer agents. Vindesine is a recent vinca alkaloid derivative with anti-tumor effects shown in in vitro systems and in patients with acute lymphocytic leukemia (ALL). The present study was designed to investigate the therapeutic effectiveness and toxicity of vindesine in combination with prednisone for remission induction in late stage ALL in children. Sixteen children with late-stage ALL were treated with vindesine 4.0 mg/m2/week intravenously and prednisone 60 mg/m2/day orally in four divided doses for minimum of three weeks. Thirteen children were evaluable. Of these patients, four had complete remission and four had partial response. Toxicity was well tolerated and consisted of bone pain, paresthesias, loss of deep tendon reflexes, leukopenia, and thrombocytopenia primarily. Abnormal liver function tests and fever were also noted in some patients. All patients had received vincristine and prednisone prior to vindesine prednisone combination. All patients had been resistant to vincristine prednisone combination prior to vindesine prednisone treatment. This study suggests effectiveness of vindesine in late stage ALL and lack of cross-resistance of vindesine and vincristine.