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Thienprayoon R, Heym KM, Pelfrey L, Bowers DC. Accidental overdose of intrathecal cytarabine in children. Ann Pharmacother 2013; 47:e24. [PMID: 23606548 DOI: 10.1345/aph.1s028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report 2 cases of intrathecal cytarabine overdose in children with cancer, neither of whom underwent cerebrospinal fluid (CSF) exchange per current recommendations or developed apparent toxicity related to the event. CASE SUMMARY A 17-year-old female with newly diagnosed acute myeloid leukemia received 177 mg of intrathecal cytarabine rather than the appropriate dose of 70 mg. She was monitored closely with no apparent toxicity from the event. A 4-year-old boy with newly diagnosed precursor B-cell acute lymphoblastic leukemia received 175 mg of intrathecal cytarabine rather than the appropriate dose of 70 mg. CSF was immediately withdrawn and intrathecal hydrocortisone was instilled for possible antiinflammatory effect. He developed no apparent toxicity from the event. DISCUSSION Cytarabine is an important chemotherapeutic agent in the treatment of leukemia. One case report of intrathecal cytarabine overdose was identified in the literature, which recommended CSF exchange as management. Neither child in our report underwent CSF exchange or developed apparent toxicity related to the event. Institutional changes were made in both cases to prevent similar events. CONCLUSIONS These cases demonstrate that measures such as CSF exchange are not uniformly required for cytarabine overdose.
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Affiliation(s)
- Rachel Thienprayoon
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas at Southwestern Medical Center, Dallas, TX, USA.
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Abstract
Autologous bone marrow transplantation can induce long-term LFS in 20% to 40% of patients with relapsed acute leukemia and should be considered as salvage therapy for patients who lack an HLA-matched donor and for patients over 45. Adult ALL patients and children with ALL in extramedullary relapse beyond second CR should receive alloBMT if at all possible. The role of ABMT in acute leukemia patients in first CR remains unclear despite randomized trials (Table 2). Because protocol deviations, early relapse, and inappropriately high treatment-related mortality unequally affected the ABMT cohort, and because recent randomized trials have used old purging methodologies, it is not possible to conclude that ABMT is not beneficial. More recent studies show that most patients are able to proceed with the intended ABMT and that modern purging may be associated with a treatment-related mortality rate of less then 5%. Immunomodulation and graft engineering uniquely suited to autologous progenitor cells indicate that ABMT should continue to be studied in the management of acute leukemia.
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Affiliation(s)
- B Spellberg
- Department of Medicine, Harbor-University of California Los Angeles Medical Center, USA
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Abstract
Recommendations for the treatment of ANLL in general, and in pediatrics more specifically, are still conflicting. Overall, a child diagnosed with ANLL has a 35-50% of remaining alive long term, without disease. Induction chemotherapy with cytarabine and daunorubicin will achieve remission in about 80% of children with ANLL. So far, intensifying induction chemotherapy by adding more agents has not changed this result significantly. Major changes in induction chemotherapy may come from either new chemotherapeutic agents or biological agents that hasten bone marrow recovery after treatment. Such an approach might allow more dose-intensive drug administration without increased toxicity. Another question that is slowly being answered with the ongoing trials is the one concerning maintenance. So far, all the pediatric trials that have tried to shorten the maintenance therapy of this disease were able to do so without jeopardizing the final outcome. The final optimal minimal duration of therapy has yet to be established. The best therapy for a patient who has achieved a remission is still the most difficult question regarding the treatment of this disease. So far, allogeneic BMT has yielded the best results, with a disease-free interval varying between 55 and 65%. However, one-third of these patients have chronic GvHD and, therefore, a somewhat diminished quality of life. As preparative regimens and marrow purging protocols evolve, the results of autologous bone marrow transplantation seem to be improving, with disease-free intervals of 35-50% reported.
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Affiliation(s)
- F Boulad
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
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Liang DC, Jiang CJ. Epirubicin and cytosine arabinoside for the induction therapy of childhood acute nonlymphocytic leukemia. Am J Hematol 1991; 38:267-70. [PMID: 1746534 DOI: 10.1002/ajh.2830380403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Epirubicin, a new anthracycline, was used in combination with cytosine arabinoside for the induction therapy of de novo acute nonlymphocytic leukemia in childhood. The treatment consisted of epirubicin 20 mg/m2/day for 3 days and cytosine arabinoside 100 mg/m2/day for 7 days. The treatment could be repeated every 3 weeks. Remission induction rate was 80% (20/25). Moreover, in 13 patients, the remissions were obtained after a single course. In general, the side effects of epirubicin and cytosine arabinoside were tolerable. However, the main causes of all the three deaths were infections. Our study suggests that epirubicin is acceptable and effective for the induction therapy for de novo acute nonlymphocytic leukemia in childhood.
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Affiliation(s)
- D C Liang
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
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Hermann J, Plenert W, Zintl F, Fuchs D, Malke H, Dörffel W, Eggers G, Exadaktylos P, Hilgenfeld E, Kotte W. Improved treatment results in childhood acute nonlymphoblastic leukemia with the BFM-AML protocol 78 in a multicenter study in the GDR. HAEMATOLOGY AND BLOOD TRANSFUSION 1987; 30:76-82. [PMID: 3305226 DOI: 10.1007/978-3-642-71213-5_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Eighty-seven children with acute nonlymphoblastic leukemia were treated with the AML protocol BFM 78 between June 1979 and February 1986 in a multicenter study in the GDR. Seventeen children (20%) died from early complications, eight did not respond to therapy. Fifty-eight patients (70%) achieved a complete remission. Twenty-three patients relapsed. The life table analysis revealed after 5 years a probability for event-free survival of 36% (SD = 6%) and an event-free interval of 51% (SD = 8%). Six patients were transplanted in first remission. Two of them died; one (M 1) on day + 19 from encephalopathy and one (M 4) on day + 60 from acute GVHD. The overall results are in good correlation with the original BFM study, but there are differences in the subtypes. Results are superior to other AML protocols in our group.
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Ferster A, Verhest A, Vamos E, De Maertelaere E, Otten J. Leukemia in a trisomy 21 mosaic: specific involvement of the trisomic cells. CANCER GENETICS AND CYTOGENETICS 1986; 20:109-13. [PMID: 2935244 DOI: 10.1016/0165-4608(86)90113-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Acute monoblastic leukemia was diagnosed in a 32-month-old boy with mild signs of Down's syndrome. Chromosome analysis of cultured skin fibroblasts and peripheral blood lymphocytes disclosed a constitutional mosaicism (46,XY/47,XY,+21). At initial diagnosis of acute leukemia, additional chromosomal changes were found in bone marrow blasts that were consistent with the M5 subtype. The cytogenetic markers of the acute leukemia were restricted to the trisomic subset and disappeared during remission. These findings add further weight to the suggestion that the propensity of Down's syndrome patients to develop leukemia is directly related to their karyotype abnormality and that leukemia might be clonal in origin.
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Abstract
The authors review the advances of the last decade in bone marrow culture cytogenetics and immunology that have aided in understanding the pathophysiology of acute nonlymphocytic leukemia and they also discuss the major strides in treatment that have occurred.
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Abstract
Eighteen children with acute nonlymphoblastic leukemia were entered on a pilot protocol. The drugs used were vincristine, daunorubicin, cytosine arabinoside, and prednisolone for remission induction, high-dose cyclophosphamide together with vincristine and mercaptopurine for consolidation, and cycles of vincristine, prednisolone, mercaptopurine, methotrexate, and daunorubicin for maintenance therapy. Prophylactic central nervous system therapy (cranial radiotherapy 2400 rad and intrathecal methotrexate 10 mg/m2 for five doses) was given once remission had been achieved. Fourteen of the 18 children (78%) achieved complete remission (CR) and 50% of those achieving CR remain in CR for 35+ to 87+ months. Survival for all children ranges from 2 to 88+ months with 50% remaining alive for 36+ to 88+ months. The protocol was well tolerated with minimal side effects. These results together with those of other recently reported studies indicate an improving prognosis for acute nonlymphoblastic leukemia in childhood.
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Ritter J, Creutzig U, Riehm HJ, Schellong G. Acute myelogenous leukemia: current status of therapy in children. Recent Results Cancer Res 1984; 93:204-15. [PMID: 6382480 DOI: 10.1007/978-3-642-82249-0_8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Creutzig U, Schellong G, Ritter J, Sutor AH, Riehm H, Langermann HJ, Jobke A, Kabisch H. Improved results in treatment of acute myelogenous leukemia in children--report of the German cooperative AML study BFM-78. HAEMATOLOGY AND BLOOD TRANSFUSION 1983; 28:46-50. [PMID: 6345292 DOI: 10.1007/978-3-642-68761-7_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Preisler HD, Brecher M, Browman G, Early AP, Walker IR, Raza A, Freeman A. The treatment of acute myelocytic leukemia in patients 30 years of age and younger. Am J Hematol 1982; 13:189-98. [PMID: 6983831 DOI: 10.1002/ajh.2830130302] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The treatment of acute myelocytic leukemia in childhood and young adults has lagged behind that for acute lymphocytic leukemia. The studies described here were directed towards evaluating the role of intensive chemotherapy in the treatment of this illness. Intensive remission induction therapy combining cytosine arabinoside with an anthracycline antibiotic produced a complete remission rate comparable to that achieved in acute lymphocytic leukemia (45 of 49 patients or 92%). Intensive consolidation chemotherapy produced a median duration of complete remission of 160 weeks with 40% of patients projected to be in remission at 4 years. By contrast, the median duration of remission for patients treated with moderate consolidation/maintenance therapy was 23 weeks with only 10% of patients in remission at 4 years. These studies demonstrate that intensive chemotherapy can be administered to pediatric patients and young adults and that this approach to therapy produces a high remission rate with a 3 year median duration of remission.
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Amadori S, Petti MC, Pacilli L, Papa G, Mandelli F. Therapy of Acute Nonlymphocytic Leukemia in Children: A Review of 73 Patients. TUMORI JOURNAL 1981; 67:209-14. [PMID: 7025401 DOI: 10.1177/030089168106700308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since 1969, 73 children with acute nonlymphocytic leukemia have been admitted for evaluation and treatment at the Institute of Hematology of the University of Rome. Various drug regimens, basically including daunomycin and/or cytosine arabinoside, were employed both for induction and maintenance treatment. Overall, the incidence of complete remission was 63 %. The availability of intensive supportive measures starting in 1974 appears to be the most likely explanation for the higher response rate observed since then. Duration of remission and overall survival were disappointingly short owing to the high frequency of bone marrow relapse. Carefully controlled clinical studies will in the future be necessary to explore better methods of preventing leukemic relapse.
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Abstract
Children with T-cell ALL have a biologically distinct subset of disease and require special treatment. This T-cell protocol suggests that the selection of chemotherapeutic agents, the emphasis on extramedullary prophylaxis, and thymectomy may be one rational approach to the treatment of these patients. The therapy program is highly immunosuppressive and requires expertise in pediatric supportive care. Future considerations must recognize the importance of T-cell subsets (Reinherz et al. 1979) as well as the use of antileukemic monoclonal antibodies and other innovative approaches to therapy.
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Castleberry RP, Crist WM, Holbrook T, Malluh A, Gaddy D. The cytosine arabinoside (Ara-C) syndrome. MEDICAL AND PEDIATRIC ONCOLOGY 1981; 9:257-64. [PMID: 6941069 DOI: 10.1002/mpo.2950090309] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Four patients with non-Hodgkin lymphoma and two with acute lymphocytic leukemia (ages 4 and 4 months to 16 years 6 months) exhibited a unique reaction to intravenously administered cytosine arabinoside (Ara-C) given alone as a part of the previously reported LSA2-L2 treatment protocol. The syndrome was characterized by fever, myalgia, bone pain, and occasionally by chest pain, maculopapular rash, and conjunctivitis. Each of the eleven episodes of this syndrome occurred within 6-12 hours of drug infusion and always abated after cessation of Ara-C. Prior to the reaction, patients had been on therapy for an average of 13.5 months during which they were exposed to 2298-5387 mg/m2 (mean of 3200 mg/m2) of Ara-C. The high incidence of this syndrome (50% of our patients on the LSA2-L2 regimen and 33% of those receiving Ara-C) has not been previously reported. Considering the prolonged exposure to Ara-C and our inability to document infections in the patients or pyrogens contaminating the drug lots, the most likely explanation for this syndrome is a hypersensitivity reaction to Ara-C. Prevention of these symptoms with corticosteroids supports this contention and provides a reasonable alternative to discontinuing Ara-C.
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Discovery and Development of Doxorubicin. Med Chem 1981. [DOI: 10.1016/b978-0-12-059280-7.50007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Mayer RJ, Weinstein HJ, Rosenthal DS, Coral FS, Nathan DG, Frei E. VAPA10: a treatment program for acute myelocytic leukemia. HAEMATOLOGY AND BLOOD TRANSFUSION 1981; 26:45-52. [PMID: 6947937 DOI: 10.1007/978-3-642-67984-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Weinstein HJ, Mayer RJ, Rosenthal DS, Camitta BM, Coral FS, Nathan DG, Frei E. Treatment of acute myelogenous leukemia in children and adults. N Engl J Med 1980; 303:473-8. [PMID: 6930539 DOI: 10.1056/nejm198008283030901] [Citation(s) in RCA: 157] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We designed a protocol to address the problem of relapse from complete remission in acute myelogenous leukemia. Patients in remission were treated for 14 months; early and later intensification of chemotherapy, sequential drug combinations, and high-dose continuous infusions of cytarabine were included. Eighty-three consecutive patients under 50 years of age were entered into this study from February 1976 to October 1979. The rate of complete remission is 70 per cent. A Kaplan-Meier analysis predicts that 49 +/- 17 per cent of patients (mean +/- 2 S.D.) who entered complete remission will remain free of disease at two years. Durations of complete remission for patients in the 0 to 17-year and 18 to 50-year age groups are comparable.
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Baehner RL, Bernstein ID, Sather H, Higgins G, McCreadie S, Chard RL, Hammond D. Improved remission induction rate with D-ZAPO but unimproved remission duration with addition of immunotherapy to chemotherapy in previously untreated children with ANLL. MEDICAL AND PEDIATRIC ONCOLOGY 1979; 7:127-39. [PMID: 291771 DOI: 10.1002/mpo.2950070206] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In 163 children with acute nonlymphocytic leukemia (ANLL), a D-ZAPO induction program consisting of daunomycin, 5-azacytidine, cytosine arabinoside, prednisone, and vincristine resulted in a remission rate of 71.8%. Immunologic therapy was employed during maintenance with the aim of prolonging remission and improving survival. The administration of immunotherapy consisting of a mixture of bacillus Calmette-Guérin (BCG) and allogenic acute myelomonocytic leukemic cells injected intradermally on day 14 of each of the first three monthly cycles of 6-thioguanine for ten days, 5-azacytidine and cytosine arabinoside for four days, and vincristine for one day did not improve remission duration or survival compared to that due to chemotherapy alone. Important prognostic factors identified in this study included a remission induction rate significantly better for females than males (P = 0.04), for children between the ages of 5 and 10 years compared to those greater than this age group (P = 0.01), and a prolonged remission duration (P = 0.04), and survival (P less than 0.01) for patients with initial white blood counts of less than 20 x 10(9)/liter.
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Levey RH, Sallen S, Weinstein H, Jaffe N. Surgical techniques for vascular access for chemotherapy in infants and children. J Pediatr Surg 1978; 13:724-9. [PMID: 569692 DOI: 10.1016/s0022-3468(78)80122-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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