[Preliminary results of BFM 96 protocol in treatment of childhood ALL relapse in the experience of the Polish Paediatric Leukaemia /Lymphoma Study Group]. / Wstepne wyniki leczenia i nawrotu ostrej bialaczki limfoblastycznej cobl wg programu BFM 96 u Dzieci w Materiale Polskiej Grupy ds. Leczenia Bialaczek i Chloniaków.

Between 1998 and 1999, 36 children aged from 3 months to 18 years (10 girls and 26 boys) with first relapse of acute lymphoblastic leukaemia were included in the study. The children were treated according to the BFM 96 relapse protocol. There were 24 cases with early (including 9 children with very early) and 12 cases with late relapse ( BM-20, local extra BM-6, combined 10). The overall second complete remission (CR) rate was 83,33%. The probability of overall EFS after 2 years was 73,3%. The results obtained with BFM 96 chemotherapy in children with first late relapse are acceptable. For children with early relapses, megachemotherapy with BMT in second remission should be used.

[The efficacy of BFM-90 program in the treatment of acute lymphoblastic leukemia in children in the studies of Polish pediatric leukemia/lymphoma group]. / Skutecznosc programu BFM-90 w leczeniu nawrotów ostrej bialaczki limfoblastycznej u dzieci w materiale Polskiej Pediatrycznej Grupy ds. Leczenia Bialaczek i Chloniaków: analiza niepowodzen.

Between years 1993 and 1998, 113 children aged from 6 months to 18 years (41 girls and 72 boys) with first relapse of acute lymphoblastic leukaemia (ALL) were included in the study. All children were treated according to BFM-90 relapse protocol. Thirty-two cases were classified as very early relapses, 56 as early and 25 as late relapses. Sixty-one children had isolated bone marrow relapse, in 30 children extramedullary relapse occurred (in 21 children in central nervous system and in 16 children in testes). There were 23 combined relapses. Remission was achieved in 12 children with very early relapse (78.12%), 32 children with early relapse (85.71) and 19 children with late relapse (96%). Event-free survival in 30 months of follow-up was 29.2%, 59.0% and 73.2% for very early, early and late relapses, respectively. Sixteen children with relapsed ALL after chemotherapy according to BFM-90 relapse protocol underwent high-dose therapy with hematopoietic stem cell transplantation (in 3 cases autologous and in 13 cases allogeneic). In 6 children isolated bone marrow relapse occurred after transplantation, all of them died during subsequent chemotherapy. Ten children is alive and well from 2 to 43 months after transplantation. The results obtained with BFM-90 chemotherapy in children with first early relapses are not acceptable. Such patients require high-dose chemotherapy and transplantation of hematopoietic progenitor cells.

[Vaccination against influenza in children with acute lymphoblastic leukemia]. / Szczepienia przeciw grypie dzieci chorych na ostra bialaczke limfoblastyczna.

In November and December 1993, 49 children, ages 4 to 20, suffering from acute lymphoblastic leukemia, were vaccinated against influenza in the Department of Paediatric Haematology and Oncology, Medical Academy in Warsaw. These patients were vaccinated either in the course of maintenance treatment or after treatment. Each dose of Wyeth USA subunit trivalent influenza vaccine contained 15 micrograms of hemagglutinin of strains recommended for that season. The level of antibody production was determined in pre- and post vaccination sera in the group of children with leukemia and the control group. It was determined that in the investigated group, the GMT increased more than four times for hemagglutinins H1N1 and H3N2. A somewhat lower increase was observed in case of hemagglutinin HB. The proportion of subjects protected after vaccination was 35% for hemagglutinin H1N1, 76% for H3N2 and 100% for HB. The response rate was 33% for hemagglutinin H1N1, 47% for H3N2 and 45% for HB. In the control group the proportion of subjects protected and the response rate were very low. The results show the significant immunological efficacy of the vaccine used in the vaccination against influenza in high risk groups.

Cytomegalovirus infection in children with blood diseases.

The study included 68 children aged from 1 to 16 years treated for acute leukemias and bone marrow aplasia. Cytomegalovirus antigen (CMV) was detected by immunofluorescence in urinary sediment cells and in cell cultures after their inoculation with CMV. Besides, the activity of IgG and IgM classes of antibodies against CMV was determined. Presence of one or more markers of CMV infection was demonstrated in 31 children, i.e., 45.5%. In eight children (11.7%) clinical manifestation of CMV infection were demonstrable with fever, hepatitis, pneumonia, rash. In all the children who completed the treatment with hyperimmune globulin, regression of clinical symptoms and signs of CMV infection with the elimination of virus antigen from urine was achieved.