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Biomedical subjects

C Pochedly

Publications and source records attributed to C Pochedly.

At least 19 recordsLinked to original sources
PubMed1991

Lower incidence of meningeal leukemia when prednisone is replaced by dexamethasone in the treatment of acute lymphocytic leukemia.

In 1971, Cancer and Leukemia Group B (CALGB) mounted a study of acute lymphocytic leukemia (ALL) that compared the effects of the two steroid hormones dexamethasone and prednisone. Six-hundred-forty-six children and adolescents with ALL were randomized to receive either prednisone or dexamethasone as part of their remission induction therapy. The 493 evaluable patients who achieved complete remission received the same steroid as pulses throughout remission. Specific central nervous system (CNS) therapy was randomized to either six injections of intrathecal methotrexate (IT MTX) alone or to six injections of IT MTX with cranial radiation (2,400 cGy). Both cranial radiation and dexamethasone offered increased protection against CNS relapse as the first site of failure over IT MTX alone. There were 30 CNS relapses among 238 patients (12.6%) receiving cranial radiation plus IT MTX, whereas there were 70 CNS relapses among 225 (P less than 0.001) (22.5%) in those who received IT MTX alone. Similarly, there were 33 CNS relapses among 231 (14.3%) children treated with dexamethasone, whereas there were 67 CNS relapses among 262 (25.6%) treated with prednisone (P = 0.017). Both steroids appeared equal in protecting the bone marrow. Recent national studies have shown significant improvements in preventing CNS relapse over the results in the present report. However, this finding warrants further investigation and, with further documentation, could lead to the substitution of prednisone by dexamethasone to aid further in preventing CNS relapse. This may be particularly important in patients at higher risk for CNS relapse.

Adolescent↗
PubMed1990

Prevention of meningeal leukemia. Review of 20 years of research and current recommendations.

By use of prophylactic CNS therapy, the incidence of meningeal relapse has been dramatically reduced and the length of the initial bone marrow remission has been greatly prolonged in children with acute lymphoblastic leukemia. Pinkel performed a controlled study in which 94 patients were randomized to one of two regimens of presymptomatic CNS therapy, or received no prophylactic CNS therapy. This crucial study showed that prophylactic CNS therapy was very useful both in preventing meningeal relapse and in prolonging the duration of complete remission. Then, many additional regimens for prophylactic CNS therapy were tried on thousands of children worldwide in an effort to improve upon these results. Among the many CNS therapy regimens that were tried, none gave results better than the original St. Jude regimen. Our knowledge of CNS leukemia in general has greatly increased, but the last 20 years have brought us no further significant progress as to improved results in preventing meningeal leukemia. The many novel and innovative CNS therapy regimens that have been tried have yielded essentially the same results as to prevention of meningeal leukemia and as to duration of disease-free survival. Five to ten percent, or fewer in patients at low risk, still show meningeal relapse, and nearly one half of children with ALL still have hematologic relapse within the first 5 years following initiation of therapy. The goal now is to reduce neurotoxicity. Thus, progress has been stymied and we now await some new addition to therapy that will dramatically improve our results. Nonetheless, there are still many promising avenues of research yet to be explored. Meningeal leukemia remains a fascinating and satisfying field of clinical research.

Child↗
PubMed1987

Laboratory testing for infectious mononucleosis. Cautions to observe in interpreting results.

In the vast majority of cases, diagnosis of infectious mononucleosis is relatively simple and the illness is not serious. Performing tests for specific Epstein-Barr virus (EBV) antibodies in these cases is not necessary. However, when the clinical manifestations are atypical or unusually severe, especially when the heterophil antibody test is negative, specific EBV antibody tests may be needed. The EBV antibodies used in diagnosis are IgG antibodies to viral capsid antigen (VCA), IgM antibodies to VCA, and antibodies to early antigen (anti-D) and Epstein-Barr nuclear antigen (EBNA). The diagnosis of infectious mononucleosis may be made when IgG-VCA, IGM-VCA, and anti-D antibodies are present and EBNA antibodies are absent. EBNA antibodies appear later and, together with IgG-VCA antibodies, persist indefinitely. Still, infectious mononucleosis often cannot be diagnosed with certainty because of the difficulties in interpreting laboratory findings. The diagnosis must be made with caution and possible sources of error considered when test results are interpreted.

Antibodies, Heterophile↗
PubMed1987

Histiocytosis-X: an overview.

This article acts as an overview of this issue of Hematology/Oncology Clinics of North America. We discuss the several themes that recur in the research and therefore in this issue concerning histiocytosis-X.

Histiocytosis, Langerhans-Cell↗
PubMed1987

Iron deficiency anemia in children.

Even when simple iron deficiency is strongly suspected, the child with severe anemia deserves a careful and thorough work-up before treatment is begun. Many other possible causes of anemia need to be excluded. No one test specifically identifies iron deficiency, but the combined use of several tests of iron status can establish iron deficiency with certainty. Hemoglobin level, mean corpuscular volume, serum iron, total iron binding capacity, free erythrocyte porphyrin and serum ferritin are the important studies.

Anemia, Hypochromic↗
PubMed1985

Emergence of pediatric hematology/oncology as an independent specialty.

The slow emergence of pediatric hematology as a recognized specialty was due to the fact that blood diseases were of relatively little concern to early pediatricians. Infectious and nutritional disorders were far more urgent problems. However, in the early 1940s it became apparent to some that pediatric hematology was acquiring a well-defined body of knowledge which would qualify it as being a discrete discipline of medical science. But in order to win independent status in the academic and political arenas, acquisition of other credentials and additional achievements were needed. These academic-political needs included the organization of training programs, establishment of a certifying examination, publication of a specialty journal, and the founding of a professional society. These achievements were accomplished by the foresight, cooperation, and hard work of many people. Yet there are many unsatisfied needs that remain.

Argentina↗
PubMed1985

Dr. Alvin M. Mauer. Early studies in white cell kinetics.

Certain serendipidous events shaped the professional career of Dr. Alvin Mauer and made it possible for him to complete research that exerted a powerful influence on our understanding of the kinetics of granulocytes and leukemia cells. The availability of the isotope, P32-tagged diisopropyl fluorophosphate (DFP32), was essential to the successful conduct of his early studies on granulocyte kinetics. Later the availability of tritium-labeled thymidine made it possible to label specific subpopulations of dividing leukemic cells and to precisely determine their proliferative characteristics and other biological features. The establishment of comprehensive centers for management of children with hemophilia was made possible by the discovery of the technique used in the preparation of cryoprecipitate. Comprehensive care of these children for the first time became feasible and cost-effective.

Cell Cycle↗
PubMed1984

Dr. James A. Wolff. I. Early progress in treatment of Rh hemolytic disease.

Dr. James Wolff's interest in hematology began while he was assigned on the transfusion service in a field hospital in the European Theatre during World War II. His interest was increased during his pediatric residency at the Boston Children's Hospital (1945-1947). At that time, Dr. Louis Diamond was involved in his important studies on treatment of erythroblastosis fetalis by exchange transfusion. Drs. Farber and Diamond were also involved with the initial clinical trials of aminopterin for the treatment of acute leukemia. The concept of treating erythroblastosis fetalis by exchange transfusion grew from our understanding of the pathophysiology of this disease, as first explained by Philip Levine and Alexander Wiener. Three techniques of exchange transfusion were tried. Diamond's umbilical catheter technique, because of its relative ease and simplicity and because it could be used for multiple exchanges, soon became the accepted method for treating infants with erythroblastosis fetalis.

Erythroblastosis, Fetal↗
PubMed1984

Dr. James A. Wolff. II. First successful chemotherapy of acute leukemia.

Until the late 1940s, no therapy was available for leukemia other than blood transfusion and a few antimicrobial agents. The disease ran its course uninfluenced by this treatment; most children died in a matter of a few months. The success of nitrogen mustard in the treatment of lymphomas and chronic leukemias encouraged efforts to try various drugs in the treatment of acute leukemia. In 1948, Farber and colleagues at the Boston Children's Hospital reported that aminopterin produced complete remissions in about one-third of children with acute leukemia. The dramatic success of this trial proved to be a monumental step forward for the field of cancer chemotherapy. Dr. Wolff was a pediatric resident and hematology fellow at the Boston Children's Hospital during the time that this important study was done. His first-hand experience gives valuable historical insight into how this giant step in cancer therapy research was accomplished.

Acute Disease↗