Prognosis of Down's syndrome with acute leukaemia
Article Abstract:
Down's syndrome is a genetic disease caused by an abnormal number of chromosomes and is characterized by moderate-to-severe retardation. Studies have shown that children with Down's syndrome are 15 to 30 times more likely to develop leukemia, cancer of the blood-forming organs. Improved care for respiratory diseases and congenital heart diseases that are common in Down's syndrome children has increased their chances for survival into adulthood. Therefore, more individuals with Down's syndrome are now developing leukemia. The outcome of Down's syndrome children with leukemia is reported for 90 children, 63 (70 percent) with acute leukemia, 26 (29 percent) with acute lymphoblastic leukemia and one patient with an unspecified type of leukemia. The prognosis of the children with Down's and acute lymphoblastic leukemia was similar to 3,664 children who had the same leukemia, but without Down's syndrome. The group with Down's syndrome had a larger proportion of children with a common immunological subtype of acute lymphoblastic leukemia. Five-year survival rate in the children without Down's syndrome was 59 percent compared with 28 percent in the Down's syndrome children. Poor tolerance to chemotherapy, modified treatment protocols, and increased susceptibility to infection contributed to the poor overall survival of children with Down's syndrome and leukemia. The survival of children with acute lymphoblastic leukemia was similar in both groups. Overall, the results indicate that children with Down's syndrome who develop acute leukemia have a poor prognosis. It thought that these children have an associated abnormality that alters the metabolism of chemotherapeutic drugs. An aggressive approach using standard treatment is suggested for these patients, as opposed to modifying treatment protocols to reduce drug toxicity. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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UKALL X - an effective treatment for stage III mediastinal non-Hodgkin's lymphoma
Article Abstract:
The Medical Research Council United Kingdom acute lymphoblastic leukaemia X D protocol, abbreviated UKALL-X, represents one arm of a current trial for the treatment of acute lymphoblastic leukemia. This protocol was applied to a study group of 15 children (11 boys) with mediastinal non-Hodgkin's lymphoma (MNHL). A second protocol, the United Kingdom Childhood Cancer Study Group (UKCCSG), used intermittent multiple drug regimens, and was the basis of treatment for the control group. The UKALL treatment pattern called for intense induction and consolidation of chemotherapy and continued oral medication. The 15 children in the study group had stage III mediastinal lymphoma with extensive involvement above the diaphragm but without bone marrow or central nervous system involvement. The control group of 14 children had been treated earlier, prior to the acceptance of the UKALL protocol. All the children were in the age group of 1 to 15 years old, and both groups had the same sex distribution. The UKALL protocol was well tolerated, and all children went into remission, although the youngest died one year after diagnosis. The survival rate for the study group, after 46 months, was 93 percent. The control group, which received intermittent therapy, had a survival rate of only 57 percent. The results of the study suggested that the UKALL X protocol is an effective treatment modality for this disease. The UKCCSG has since adopted the UKALL protocol for national use. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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Impaired pubertal growth in acute lymphoblastic leukaemia
Article Abstract:
In recent years the long-term survival rate for children with lymphoblastic leukemia has improved dramatically. This is largely due to the combined use of cranial irradiation (radiation therapy applied to the head) and chemotherapy with methotrexate. Previous studies have reported that cranial irradiation may damage the pituitary gland in the brain, resulting in a deficiency of growth hormone and reduced growth. Also, it has been associated with premature puberty in girls. This article describes the treatment and outcome of 182 patients who were long-term survivors of childhood acute lymphoblastic leukemia. The dose of radiation used during cranial irradiation was 2,400 cGy in 93 of the patients and 1,800 cGy in 89 of the patients. In addition, all patients were treated with methotrexate. The patients treated with the lower dose of radiation reached puberty at an earlier age and reached their final height at an earlier age than those treated with the higher dose of radiation. Treatment with either dose of cranial irradiation prior to the age of seven resulted in a greater decrease in the final height of the patient than treatment after the age of seven, and this effect was greater in girls than in boys. Treatment with the lower dose of radiation was associated with an earlier onset of puberty in girls. It is concluded that cranial irradiation performed in girls less than seven years of age is associated with premature puberty and impaired growth. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1991
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