mercaptopurine and Abdominal-Neoplasms

Seventy-three patients with Stage III abdominal non-Hodgkin's lymphoma were prospectively treated following two sequential protocols (P): L278 P (group A, 33 patients) (1978-1983) and L384 P (group B, 40 patients), (1984-1991). No patient received radiotherapy. The L278 P included 7 drugs: cyclophosphamide, vincristine (VCR), adriamycin (ADR), prednisone, methotrexate (MTX), dexamethasone, and 6-mercaptopurine, given for remission induction, maintenance, and CNS prophylaxis. In the L384 P we introduced a consolidation phase consisting of intravenous MTX and citrovorum factor rescue, and IV cytosine arabinoside. VCR was also added to the monthly doses and the maintenance phase was reduced from 18 to 15 months. From January 1988 we changed ADR for epirubicin in the same doses. Prophylactic treatment of the CNS, in the L384 P, was intensified by increasing the number of doses of MTX IT in the remission, induction, and consolidation phases, and with the use of ara-C IT. Laparotomy in 50 patients allowed partial resection in 16, and second-look laparotomy was performed in 27 patients. Viable tumor was found in four patients. Three patients (G-A) died from metabolic complications and another 4 (2 G-A and 2 G-B) failed to attain CR and died. A total of 28 (85%) of 33 children of G-A and 38 (95%) of 40 children in G-B achieved CR. Five children died in remission (2 G-A, 3 G-B). Three patients (G-A) relapsed in the CNS and one (G-B) relapsed in the abdomen and died. Disease-free survival at 120 months was 70% in G-A and 84% in G-B.

Topics: Abdominal Neoplasms; Antineoplastic Combined Chemotherapy Protocols; Central Nervous System Neoplasms; Child; Child, Preschool; Costa Rica; Cyclophosphamide; Cytarabine; Dexamethasone; Doxorubicin; Female; Humans; Infusions, Intravenous; Leucovorin; Life Tables; Lymphatic Metastasis; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Methotrexate; Neoplasm Recurrence, Local; Prednisone; Prospective Studies; Remission Induction; Survival Rate; Vincristine

We report a 5.5-year-old boy who underwent autologous peripheral blood stem cell transplantation for high-risk acute lymphoblastic leukemia and who had two abdominal masses develop 6 months later. Macroscopically complete resection of the abdominal tumors was performed and revealed a well-differentiated leiomyosarcoma. Smooth muscle tumors, benign or malignant, are increasingly recognized in children with various immunodeficiencies; the association with acute lymphoblastic leukemia is rarely described.

Topics: Abdominal Neoplasms; Anthracyclines; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Child, Preschool; Cortisone; Disease Susceptibility; Female; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Immunologic Deficiency Syndromes; Leiomyosarcoma; Leukemia-Lymphoma, Adult T-Cell; Mercaptopurine; Neoplasms, Second Primary; Remission Induction; Transplantation Conditioning; Transplantation, Autologous; Vincristine; Whole-Body Irradiation

Most complications of 6-mercaptopurine (6MP) used in the treatment of inflammatory bowel disease (IBD) occur early, whereas neoplasms occur late in the course. Concern persists that the risk is increased when 6MP is used. We report our experience with malignant tumors developing over 27 yr of treating IBD patients with 6MP.. A total of 591 patients with IBD treated with 6MP between 1969 and 1997 were followed or traced until present to identify all malignant tumors and blood dyscrasias that had developed to determine the type, distribution, and duration of the IBD, the dose and duration of 6MP therapy, the concurrent versus previous use of 6MP, the incidence and probable relationship of 6MP to specific neoplasms, and whether the 6MP had been effective in treatment.. A total of 550 patients (93%) fulfilled the criteria for follow-up; these included 380 with Crohn's disease (CD) and 170 with ulcerative colitis (UC). Twenty-five patients had developed neoplasms (16 of 380 CD and nine of 170 UC) (p = 0.66). In half of the cases, the goal of therapy had been achieved with 6MP. In 10 patients, the neoplasm was diagnosed while the patients were taking 6MP (40%) and in 15, many years after the 6MP had been terminated (60%). The incidence of neoplasms (25 of 550) was 2.7/1000 patient-years of follow-up. The most common neoplasms were found in the bowel (eight of 550, 1.6%; five CD, and three UC), and breast (three, 0.5%; two CD, and one UC). Non-Hodgkins lymphomas occurred in two patients with CD; one was cerebral and the other abdominal. One patient with CD developed leukemia. The duration of 6MP therapy ranged from 5 months to 22 yr, with a mean of 5 yr. The dose of 6MP ranged from a quarter of a tablet/day (12.5 mg) to 100 mg/day, with the majority in a range from 50 to 75 mg/day.. In no instance could a neoplasm be attributed to the use of 6MP. The incidence of colon cancer is not greater than that with long standing colitis. Suspicion of a relationship between 6MP and leukemia/lymphoma persists, but the incidence is low. This must be weighed against the improved quality of life due to 6MP for patients with IBD.

Topics: Abdominal Neoplasms; Adult; Aged; Aged, 80 and over; Brain Neoplasms; Breast Neoplasms; Colitis, Ulcerative; Crohn Disease; Drug Administration Schedule; Female; Follow-Up Studies; Hematologic Diseases; Humans; Immunosuppressive Agents; Incidence; Inflammatory Bowel Diseases; Intestinal Neoplasms; Leukemia; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Middle Aged; Neoplasms; Risk Factors; Time Factors

Twenty-one children with non-Hodgkin's lymphoma (NHL) entered intensive chemotherapy study according to the protocol 6481. Sixteen patients with extraabdominal involvement achieved long-lasting remission, 15 of them have been disease-free for 17 till 77 months. Five children suffered from intraabdominal NHL, 4 of them expired because of progression of the disease within 4 months after diagnosis, 1 patient has been disease-free for 43 months. Actuarial disease-free survival is 0.76 for the whole group, 0.8 for those with extraabdominal involvement and 0.20 for children with intraabdominal forms of non-Hodgkin's lymphoma. Protocol 6481 is highly effective for extraabdominal forms of childhood non-Hodgkin's lymphomas but insufficient for abdominal forms.

Topics: Abdominal Neoplasms; Actuarial Analysis; Adolescent; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Bleomycin; Child; Child, Preschool; Cyclophosphamide; Cytarabine; Doxorubicin; Female; Humans; Hydrocortisone; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Methotrexate; Prednisone; Vincristine

Topics: Abdominal Neoplasms; Adolescent; Adult; Cyclophosphamide; Doxorubicin; Female; Humans; Lymphoma; Male; Mercaptopurine; Middle Aged; Prednisolone; Ultrasonography; Vincristine

Topics: Abdominal Neoplasms; Adult; Aged; Antineoplastic Agents; Breast Neoplasms; Cyclophosphamide; Doxorubicin; Drug Therapy, Combination; Female; Fluorouracil; Gallbladder Neoplasms; Hodgkin Disease; Humans; Kidney Neoplasms; Liver Neoplasms; Lymphoma, Large B-Cell, Diffuse; Male; Mercaptopurine; Middle Aged; Pancreatic Neoplasms; Prednisolone; Rectal Neoplasms; Stomach Neoplasms; Ultrasonography; Vincristine