[Alternating noncross-resistant polychemotherapy to improve the results of the treatment of Hodgkin's disease].
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Biomedical subjects
Publications and source records attributed to J Armata.
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The subject of analysis is a group of 111 children with acute lymphoid leukemia (ALL) whose remission has lasted at least 4 years since stopping treatment. Patients were observed from 4 to 18 years after ALL therapy. No symptoms of disease were observed in 110 children; one child had leukemic infiltration of the testes during the fifth year after stopping treatment. In this group of children no changes in physical development have been recorded, but a growth deficiency is sometimes noted. No symptoms of intrinsic organ lesions have been ascertained in most of the patients. All of the patients, except one with schizophrenia, lead normal lives and either attend school or go to work. Seven patients have healthy children, who were born 6-24 years after the beginning of the disease and 3-16 years after cessation of therapy.
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34 children with Non-Hodgkin's lymphoma (NHL) were treated with LSA2L2 protocol from 1978 to 1981. In 12 cases (31.4%) the central nervous system (CNS) was involved, including 3 cases at the onset of the disease. CNS involvement was always diagnosed by the presence of blast cells in cerebro-spinal fluid, also in cases with normal pleocytosis and no neurological symptoms. Such cases were called "smouldering" CNS involvement. Four children had a smouldering form of CNS involvement. 3 of them are in continuous complete remission with cessation of therapy, while all those 6 patients with symptomatic CNS involvement died. "Smouldering" CNS involvement seems to have a better prognosis than the symptomatic one.
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From 1979 to 1982, 97 previously untreated children with non-Hodgkin's lymphoma were treated with the LSA2L2 protocol proposed by Wollner. Staging was done according to the criteria proposed by Wollner and re-staged according to Murphy's criteria. Each patient, regardless of clinical stage and histologic group, was given the same chemotherapy. A total of 28 nonrandomized patients received either cranial irradiation or intermediate-dose intravenous methotrexate as CNS prophylaxis. The complete remission rate was 72.6%. The 3-year actuarial estimate of survival was 73% and the disease-free survival rate was 62% for all responders, and was influenced by stage and main clinical features present at the time of initial presentation. The overall survival rate at 3 years is 52%. Of 26 children who failed to achieve complete remission, 21 had presented with disseminated disease. Also, 20/67 patients who entered remission have suffered relapses: four in the bone marrow, seven in the CNS, and nine with local relapses. Only one of 28 children who received CNS prophylaxis developed CNS disease as the site of first relapse, whereas six of those who received only intrathecal chemotherapy did so. This study confirms the improved outlook in comparison with a historical group for children with non-Hodgkin's lymphoma by the use of an intensive multiple-drug regimen and CNS prophylaxis.
Between 1969 and 1975, 34 children aged 16 years and under, with Hodgkin's disease (HD) were treated and followed-up at our department. All patients received a combination of MVPP and radiotherapy. Four children died, three from uncontrolled lymphocyte depletion Hodgkin's disease and one from encephalopathy. Thirty children are disease-free, with the mean survival of 109.8 months.
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