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Biomedical subjects

L Sinks

Publications and source records attributed to L Sinks.

10 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↗
PubMed1981

The treatment of Wilms' tumor: results of the Second National Wilms' Tumor Study.

One-hundred-eighty-eight children up to 16 years of age were randomized in the second National Wilms' Tumor Study (NWTS) with tumors that were confined to the kidney and that had been totally excised (Group I). Most fared well whether treated for six or for 15 months with both actinomycin D (AMD) and vincristine (VCR). No postoperative radiation therapy (RT) was given. The two-year relapse-free survival (RFS) and two-year survival rates were 88 and 95%, respectively. Two-hundred-sixty-eight randomized patients with more advanced local lesions (Groups II and III) and 57 with distant metastases (Group IV) had postoperative RT and were scheduled for 15 months treatment with either AMD and VCR (Reg. C) or AMD plus VCR plus Adriamycin (Reg. D). The 77% two-year RFS rate for Reg. D was significantly different from the 63% with Reg. C. As in the first NWTS, patients with tumors of unfavorable histology (UH) had a significantly worse prognosis than those with favorable histology (FH), as did those with positive nodes. Survival rates at two years were 54% for UH vs. 90% for FH, and 54% vs. 82% for those with and without lymph node involvement.

Adolescent↗
PubMed1980

Results of the National Wilms' Tumor Study: Treatment response in misclassified patients.

This report evaluates the outcome in patients treated in accord with protocol requirements of the National Wilms' Tumor Study who were assigned incorrectly to any of several clinical groups because of mistaken initial assessments of the extent of disease. A significant difference in response was found between patients correctly staged Group I and those of higher stages incorrectly placed in Group I. This observation emphasizes the need for careful staging, and for "upstaging" in doubtful Group I patients.

Child↗
PubMed1976

Five-year remissions of metastatic solid teratoma of the ovary.

To date, only three 5-year survivors with metastatic solid malignant teratoma of the ovary have been reported. The authors report two additional cases surviving 5 years or greater. In both cases, the embryonal teratomatous elements matured to Grade 0 peritoneal metastases after intensive chemotherapy and surgery with or without radiotherapy. Since only one of the two patients had an objective response to therapy, we speculated that the maturation of the tumor in both patients might be, but is not proven to be, a consequence of chemotherapy, surgery, and/or radiotherapy. Because the prognosis, even in Stage IA solid ovarian teratoma, is so poor, we suggest that all such patients should have 2 years of adjuvant chemotherapy consisting of vincristine, dactinomycin, and cyclophosphamide. Patients with demonstrable metastases should receive the same chemotherapy until either all tumor has regressed or all immature elements have reverted to mature tissue.

Adolescent↗
PubMed1976

Granulocyte transfusions in children using filter-collected cells.

Twenty-three children with various stages and morphologic types of leukemia were treated with multiple granulocyte transfusions obtained by filtration leukapheresis when neutropenia-associated infection appeared unresponsive to antibiotics. All children meeting the above qualifications were given granulocyte transfusions during this time period. Twenty-one of 23 became afebrile during or shortly after the transfusions; one died with disseminated Herpes simplex; and one became well enough to be discharged, although he was never free of fever. Frequent mild to moderate fever and chills were noted. One child developed a severe pulmonary reaction followed by resolution of pneumonia. Filtration leukapheresis is a useful adjunct in controlling severe infections in neutropenic children.

Adolescent↗