[Therapy of recurrent acute lymphoblastic leukemia in childhood using alpha-asparginase].
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Biomedical subjects
Publications and source records attributed to H Reddemann.
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For the purpose of evaluating the efficiency of an unspecific immunostimulation in acute leukaemias the results of treatment obtained from two groups of patients (a total of 55 children) were compiled. In the first group an unspecific immunostimulation with vaccination (BCG, diphtheria-tetanus-pertussis, measles) could be observed after the induction of remission during a cytostatic maintenance therapy. In the second group a polychemical therapy and the CNS-irradiation was applied according to the treatment scheme developed by the working team of Donald Pinkel. The group of patients treated with unspecific immunostimulation involved a high percentage of surviving children. In total there was no essential difference between the treatment results of both schemes of therapy during our period of observation. As before, the treatment of hyperleukocytic forms of leukaemias will cause particular difficulties.
At present 80...90 % of the patients with acute lymphatic leukaemia die in the blastic crisis. About 10% will come ad finem during full remission caused by side effects of the treatment and their complication. The leukaemic terminal crisis may be accompanied or overlapped by a number of complications, the most frequent among own patients being acute bleeding in the terminal phase. First of all the source of bleeding is to be found in the gastro-intestinal tract (80%). Other authors found infections to be the most frequent final cause of death. It is only under autopsy that leukaemic infiltrates, infections and bleeding are completely recognized to their full extent. After polychemo-therapy the patients showed a significant increase of complications including pulmonary oedema and a marked insufficiency of the bone-marrow with leukocytopenia and granulocytopenia in the peripheral blood. Among the biochemical parameters only a generally significant increase of alpha2 and gamma globulins could be found in the serum. A correlation towards a form of therapy could not be ensured.
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The activity of phenylalanine hydroxylase in the liver without the cofactor 2-amino-4-hydroxy-6,7-dimethyl-5,6,7,8-tetrahydropterin is similar in cases of classical PKU (14 cases), mild hyperphenylalaninemias (2 cases), heterozygotes (1 case) and normal controls (18 cases). The addition of cofactor increases the activity 30-40-fold in normal controls and 2-5 fold in mild hyperphenylalaninemias or heterozygotes. In classical PKU the addition of cofactor is without effect or causes even a diminution of activity. Therefore, for classification of the various forms of hyperphenylalaninemias the effect of cofactor on enzyme activity is important. For decisions from this findings to be made as to whether treatment should or should not be used further investigations are needed.
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In 8 selected test persons of the 3rd series of experiments who were showing signs of pathological kynureninase activity, hepatic kynureninase was again established after 3 week's treatment with large doses of vitamin B6. The enormous in-vivo activation of the kynureninasis established goes to prove that apoenzyme synthesis may be stimulated by pyridoxine. On the basis of these results and the relative frequency of disorders dependent on B6, the question arises whether children from endangered families should not be given prophylactic vitamin B6 treatment from birth.
Kynureninase activity assay in oligophrenic children with hereditary taint, before and after treatment with vitamin B6. The hepatic kynureninase activity was assayed in 25 oligophrenic children with hereditary taint, and having a positive tryptophan load test. Eight cases (32%) showed an enzyme activity below the 2-s limit; in two cases, the pathologic enzyme activity could be almost normalized by addition of higher P-5-P concentrations. In a second set of studies, eight children with an abnormally low kynureninase activity were re-examined following a 3-week treatment with vitamin B6. The enormous in-vivo-activation of kynureninase reached in these studies lends support to the assumption of a vitamin-B6-dependent "inborn error of metabolism" in the tryptophan-kynurenin pathway in some of the investigated oligophrenic children with hereditary taint.
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