Complications and total care of a child with acute leukemia

Effect of neoadjuvant chemotherapy on distraction osteogenesis in the goat model

Neoadjuvant chemotherapy potentially can have an adverse effect on bone healing in distraction osteogenesis whether given before or concomitant with distraction osteogenesis. It was the purpose of the current study to determine if administration of chemotherapy before distraction adversely affects bone generation in distraction osteogenesis. Twenty-four adult dairy goats were divided randomly into two groups: a control group having distraction osteogenesis only and a chemotherapy group, receiving one course of Adriamycin before distraction osteogenesis. The animals were sacrificed at 6 weeks, 12 weeks, or 24 weeks and the lengthened tibias were evaluated by radiologic studies, biomechanical testing, and histologic analysis. All goats receiving chemotherapy showed systemic adverse effects. In a multifactorial analysis of the lengthened bones, there was no statistically significant difference between the control goats versus goats that received chemotherapy; indicating that there was no sustained inhibitory effect on bone formation by the chemotherapy. These findings suggest that a prior course of chemotherapy with Adriamycin may not be a contraindication to limb lengthening for limb salvage after resection of an osteosarcoma.

Granulocyte transfusions in children using filter-collected cells

Twenty-three children with various stages and morphologic types of leukemia were treated with multiple granulocyte transfusions obtained by filtration leukapheresis when neutropenia-associated infection appeared unresponsive to antibiotics. All children meeting the above qualifications were given granulocyte transfusions during this time period. Twenty-one of 23 became afebrile during or shortly after the transfusions; one died with disseminated Herpes simplex; and one became well enough to be discharged, although he was never free of fever. Frequent mild to moderate fever and chills were noted. One child developed a severe pulmonary reaction followed by resolution of pneumonia. Filtration leukapheresis is a useful adjunct in controlling severe infections in neutropenic children.