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Biomedical subjects

G Javier

Publications and source records attributed to G Javier.

At least 37 records · Page 2Linked to original sources
PubMed1985

[Treatment of high and low risk acute lymphoblastic leukemias in the child, with 2 modalities of preventive therapy on the central nervous system (Pethema 7/78 protocol)].

More effective therapy of high-risk patients and less toxic CNS prophylaxis are two goals in present acute lymphoblastic leukemia treatment research. Protocol LA A 7/78 was based on: 1) Distribution of patients in 2 therapy groups: standard (SR) and high-risk (HR) according to presence of clinical and hematological prognostic factors. 2) Remission induction in SR with PRED, VCR and ASPAR, and as maintenance, combination of MP and MTX. HR patients were given 4 drugs, with addition of DAUNO; reinductions with PRED, VCR and DAUNO every 3 months were given as well. 3) CNS prophylaxis in both groups was given according two modalities, on a randomized base. "A": cranial irradiation (24Gy) plus i.t. MTX, 6 doses. "B": i.t. MTX and ARA-C, 10 doses (6 weekly and 4 monthly). From 1978 to 1983, 76 patients under 14 years old were entered in study: 22 in HR and 54 in SR groups. All attained remission. After a median follow-up of 49 months estimated disease-free survival rate is 65.6% corresponding to 70% in SR and 56% in HR. Modality "B" of SNC prophylaxis (without irradiation) was, at least, as effective as modality "A" in SR and HR groups; estimated disease free survival is 60.5% +/- 9% in "A" and 71 +/- 8.5% in "B" therapy. Mortality by infections in patients in remission was less than 4%. This low proportion can be attributed in part to continuous use of cotromoxazol. Main conclusions of this study are: 1. Need for more intensive induction and consolidation therapy, especially in high-risk patients, and 2. That prolonged (5 months) intrathecal chemotherapy can substitute cranial irradiation in CNS prophylaxis.

Adolescent↗
PubMed1984

[Clinical and occult testicular relapses in children with acute lymphoblastic leukemia. Treated with the D.74 and pethema 7/78 protocols].

The incidence of testicular infiltrates in 68 boys with acute lymphoblastic leukemia in first remission (1974-81), was prospectively investigated through careful clinical exams and routine bilateral biopsies at 2-3 years of remission. All boys were under 14 years of age and they were treated with protocols D.74 and pethema 7/78. Seven patients (10.3%) presented an isolated testicular relapse (ITR) during the chemotherapy period. In 13 out of the 43 testicular biopsies (31%) leukemic infiltrates were found and in other 2 findings were controversial. Three boys, two of them whose previous biopsy was negative, had an ITR, 6 to 18 months after stopping therapy. Finally, other 3 had simultaneous relapses in testes and bone-marrow: one during chemotherapy and two after suppression. In total, 23 patients (33.8%) in first remission had overt or occult ITR. Overall incidence of testes leukemia, is calculated to be 40% in all the group. Incidence of early and occult ITR was higher in boys with initial WBC counts over 20 X 10 9/l. Therapy in ITR generally consisted in local radiotherapy (20-25 Gy), a new induction treatment followed by 2 year maintenance treatment; in 3 patients with early ITR, orchidectomy was also performed and six were given a new preventive SNC treatment. Clinical course in the 7 patients with early ITR was unfavourable in 5 with subsequent hematological relapses and death; one had a long-term disease-free survival (78 + months) and the other was a recent case. 10 out of the 13 patients with occult infiltrates followed in remission and four were of treatment with a follow-up over 64 months. The 3 patients with late ITR were in second remission at 8-14 months after a new cessation of therapy. It may be concluded from this study that prognosis in ITR is related to the phase of presentation: It is unfavourable in cases of early ITR but in cases of occult infiltrates detected by routine biopsies and in late ITR the combined therapy is effective in most cases.

Adolescent↗
PubMed1984

[Acquired aplastic anemia in children. Therapy using androgens and antilymphocyte gamma globulin].

Authors describe initial characteristics, clinical course and response to treatment of 13 children, aged from eight months to nine years, with acquired aplastic anaemia. Six of the children had been exposed to products with potential bone-marrow toxicity: chloranphenicol (1), pirazolones (3) and insecticides (2). Pancytopenia was severe in twelve and moderate in one. Five patients with severe aplastic anaemia were given antilymphocytic (2) or antithymocytic (3) (ATG) gammaglobulins; two of those treated with ATG responded after two and five months respectively and there was no response in the other three. Twelve patients were given androgen treatment (oxymetholone or nandrolone decanoate): four, two of whom previously had received ATG, followed a favorable course. None of the severe initial pancytopenic patients responded to androgen single agent treatment. No marrow transplant was performed in any of the children. Eight of the thirteen patients died one to 37 months after onset (median, 6 months) and five (38%) are alive after 21 months to 10 years, corresponding to two patients with moderate and three with severe initial pancytopenia. Importance of an appropriate supportive treatment during initial stages of the disease and the probable efficacy or immunosupressive treatment in certain patients must be underlined.

Androgens↗
PubMed1984

Testicular infiltrates in children with acute lymphoblastic leukemia: a prospective study.

The incidence of testicular infiltrates in 68 boys with acute lymphoblastic leukemia in first remission (1974-81), was prospectively investigated through careful clinical examination and routine bilateral biopsies at 2-3 years of remission. All boys were under 14 years of age and they were treated with protocols D.74 and Pethema 7/78. Seven patients (10.3%) presented an isolated testicular relapse (ITR) during the chemotherapy period. In 13 of the 43 testicular biopsies (31%) leukemic infiltrates were found, and in another two findings were controversial. Three boys, two with previous negative biopsies, had an ITR 6 to 18 months after therapy was stopped. Finally, three others had simultaneous relapses in testes and bone marrow, one during chemotherapy and two after suppression. In all, 23 patients (33.8%) in first remission had overt or occult ITR. Overall estimated incidence rate of testes leukemia is 40% in all the groups. Incidence of early and occult ITR was higher in boys with initial WBC counts over 20 X 10(9)/1. Therapy in ITR generally consisted of local radiotherapy (20-25 Gy), a new induction treatment followed by 2-year maintenance treatment; in three patients with early ITR, orchidectomy was also performed and six were given a new CNS preventive treatment. Clinical course in the seven patients with early ITR was unfavourable in five, with subsequent hematological relapses and death; one had a long-term disease-free survival (80 + months) and the other was a recent case. Ten of the 13 patients with occult infiltrates continued in remission and four were off treatment with a follow-up of over 66 months. The three patients with late ITR were in 2nd remission at 8-18 months after a new cessation of therapy. It may be concluded from this study that prognosis in ITR is related to the phase of presentation: it is unfavourable in cases of early ITR, but in occult infiltrates, detected by routine biopsy, and in late ITR combined therapy is effective in most cases.

Adolescent↗
PubMed1984

Hypothalamo-hypophyseal-testicular function in prepubertal boys with acute lymphoblastic leukemia following chemotherapy and testicular radiotherapy.

Hypothalamo-hypophyseal-testicular function was studied in twenty-eight prepubertal boys with ALL in clinical and haematological remission. Eighteen were treated with combined systemic chemotherapy (24-36 months) and the other ten, who had testicular leukemic infiltrates, received chemotherapy (38-60 months) and testicular radiotherapy (2 000 rad). Plasma levels of LH and FSH were measured before and after stimulation with LHRH (100 micrograms i.v.) and plasma levels of testosterone before and after stimulation with hCG (1 500 IU/48 h/7 doses). In patients treated with chemotherapy alone, mean basal LH and FSH, mean responses to LHRH stimulation and mean testosterone levels after stimulation with hCG did not significantly differ from those of the controls. Five of these patients who had normal testosterone values after three doses of hCG had testosterone values below the normal range after seven doses. In patients treated with chemotherapy and testicular radiotherapy, mean basal FSH and mean responses to LHRH stimulation were significantly higher than those of the controls. Testosterone values after stimulation with hCG were low in three and very low in the other seven. In both groups of patients data from testicular biopsies were consistent with functional results. We conclude that chemotherapy causes slight testicular damage, but chemotherapy and testicular radiotherapy produce severe testicular damage in patients with testicular leukemic infiltrates.

Child↗
PubMed1984

[Treatment of acute promyelocytic leukemias in children].

UNLABELLED: Acute promyelocytic leukemia (APL), besides distinctive cytological characteristics has a high incidence of haemorrhagic complications due to disseminated intravascular coagulation (DIC). Nine patients with APL, between a day and 12 years old, were studied. Diagnosis was based on cytomorphological classification FAB. Eight presented with haemorrhages and DIC were found. Five received Daunorubicin and 4 DATOP. Patients with DIC also were given substitution therapy with platelets and heparin. RESULTS: two died during the first two weeks, of intracranial haemorrhage (ICH) and sepsis respectively. Three in initial remission relapsed after 3 to 21 months and two died of ICH; the third one attained a new remission but presented a new relapse and finally died 61 months after onset. The other 4 patients are at present in their first remission of 1 to 12 months. IN CONCLUSION: APL must receive, besides specific chemotherapy, early DIC therapy; with present polychemotherapy a high remission rate and prolonged disease-free survivals can be obtained.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1982

[Evaluation of initial risk factors in acute lymphoblastic leukemias in children].

In an attempt to establish a possible correlation between clinical course and initial characteristics of the disease, 88 children with ALL (diagnosed between 1970-1978) were studied. Basis for comparison was whether relapses (medullary or extramedullary) occurred within 36 months. Twenty parameters, including history data, physical exploration, laboratory findings and early response to induction treatment, were evaluated. Statistical analysis showed a significant influence of the following factors: age less than 1 year, organomegalies (hepato or splenomegaly larger than 5 cm B.C.M.), adenomegalies (more than 3 cm in diameter), mediastinal mass, initial CNS infiltration, E-rosette forming blast-cells, acid phosphatase positivity and a good hematological response after 2nd week of treatment. Sex appeared as a prognostic factor after 36 months. Three group of patients could be distinguished according to risk factors: A) Patients without risk factors; 70.45% in continuous remission (CR) after 36 months. B) Patients with 1-2: 43.47% in CR at 36 months. C) Three or more: None attained 36 months in continuous CR. Differences are significant (p less than 0.05).

Age Factors↗
PubMed1981

[Testicular biopsies in childhood ALL (author's transl)].

Bilateral wedge biopsies were practiced in 22 boys, aged 4 to 13 years, with Acute Lymphoblastic Leukemia after 36 months in continuous remission. All the patients had been given the same chemotherapy (protocol D.74). The aim of this study was to detect the presence of residual leukemic infiltrates before suppressing therapy and to evaluate gonadal toxicity due to chemotherapy. Leukemic infiltration was found in six cases (27%) and another two were considered as doubtful cases. Interstitial space and subepithelial areas were the preferred sites of infiltration; tunica albuginea was found affected in only two cases. All patients affected were given local radiotherapy and additional chemotherapy. Interstitial oedema with fibroblasts and macrophages was the most common lesion (81%); fibrosis was observed in 20% of the cases. Changes in testicular morphology were mainly reflected by narrowing of the tubular diameter (less than 75% of average values in 63% of the cases) and decrease of the number of spermatogenic cells per 100 tubules (less than 75% of mean values in 86% of the biopsies). These changes appeared as independent of the presence of leukemic infiltrates. Conclusions. Biopsies performed in boys before suppression of therapy are considered as important; in positive cases additional local and systemic therapy must be given. Further longitudinal and functional studies are needed to verify consequences of toxic effects observed.

Adolescent↗