mercaptopurine and Nutrition-Disorders

The histological diagnosis of non-Hodgkin's lymphoma (Burkitt's lymphoma excluded) in 147 children was reviewed. The most common site of presentation was in the abdomen (32.6%). The most frequent site of metastatic disease at diagnosis was the bone marrow (27.2%). The most common histology was diffuse undifferentiated non-Burkitt type (37.4%). According to the Murphy staging system, 40.1% were stage III and 27.2% were stage IV. In a nonrandomized prospective study, 121 patients were submitted to a treatment regimen (protocol 8001) and compared with 26 historical controls treated with the COP regimen, consisting of cyclophosphamide, vincristine, and prednisone. Of those patients treated with protocol 8001, nine had intestinal perforation at the site of primary disease. All patients in this group were malnourished at the time of perforation. The overall rate of initial complete remission in those patients treated with protocol 8001 was 90.7%. The duration of remission was from 16 to 108 months, with a median of 39 months. The actuarial rate of disease-free survival was 69% at 2 years and 63% at 6 years, compared with 36% at 6 years of the control group (COP) (p less than 0.01). None of the patients have relapsed after 4 years.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Child; Child, Preschool; Clinical Trials as Topic; Cyclophosphamide; Cytarabine; Female; Humans; Hydrocortisone; Intestinal Perforation; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Methotrexate; Nutrition Disorders; Prednisone; Vincristine

To evaluate compliance in children with acute lymphoblastic leukaemia (ALL).. Compliance was assessed through specific interviews, annotations from medical charts, and erythrocytic determination of 6-mercaptopurine metabolites.. A total of 39 patients who had concluded maintenance phase of chemotherapy were included in the study. Mothers were responsible for delivering 6-MP in 87% of cases. Thirty five interviewees said that medical prescription was well understood and that the main reason for non-compliance was forgetfulness. Non-compliance was detected through interviews (33.3% of the cases), reports from medical charts (30.7%), and drug determination (16.6%); 53.8% of children were found to be non-compliant. Non-compliance was significantly associated with chronic undernourishment. Although not statistically significant, there was a trend for the group of non-compliant children to be associated with low per capita family income. No significant associations of non-compliance with age at diagnosis, gender, parents' schooling level, number of family members, power consumption, and medians of absolute leucocyte or neutrophil blood counts were detected. A short follow up period precluded valid analysis on outcome. In the non-compliant group (n = 21), seven children relapsed, contrasting with three relapses in the compliant group (n = 18).. Results suggest that non-compliance is one of the mechanisms which underlies the adverse influence of socioeconomic factors on the outcome of children with ALL. Additional studies are necessary to confirm this hypothesis. Comprehensive approaches to the problem of non-compliance are urgently needed.

Topics: Adolescent; Antimetabolites, Antineoplastic; Biomarkers, Tumor; Blood Cell Count; Child; Child, Preschool; Chronic Disease; Female; Humans; Infant; Interviews as Topic; Male; Mercaptopurine; Mothers; Nutrition Disorders; Patient Compliance; Poverty; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence

The objective of the study was to determine if children with high risk acute lymphoblastic leukemia (ALL) exhibit higher frequency of alterations in nutritional state during the phases of induction and consolidation of chemotherapy than children with low risk ALL, based on the arm muscle area. The design was concurrent comparative cohorts. It was performed at pediatric hematology service of the Hospital General del Centro Médico Nacional "La Raza" and hematology service of the Hospital de Pediatría del Centro Médico Nacional "Siglo XXI". One hundred-five patients were incorporated into the study: 53 with high risk (HR) ALL and 52 with low risk (LR) ALL. Basal measurements of arm circumference and tricipital skinfold were surveyed monthly (for 3 months) by standardized personnel. Altered nutritional state during follow-up was defined as the loss of 10% or more of the arm muscular area (AMA) measured at diagnosis. Statistics of proportion analysis with a significance level of 0.05 and relative risk (RR) with confidence intervals (CI) were calculated. In the first month the RR was 0.77 (CI 0.31-1.87); the LR group was the most affected. In the second month the RR was 7.31 (CI 1.41-38.03); the most affected group was the HR. In the third month the RR was 1.77 (CI 0.60-4.92); the HR group was the most affected. High-risk patients show a higher frequency of nutritional state alterations reflected in AMA during the second month after diagnosis. This may be caused by the more aggressive chemotherapy received by these patients.

Topics: Adolescent; Anthropometry; Antineoplastic Combined Chemotherapy Protocols; Arm; Asparaginase; Body Constitution; Child; Child, Preschool; Cohort Studies; Cytarabine; Drug Administration Schedule; Energy Metabolism; Epirubicin; Female; Gastrointestinal Diseases; Hospitals, General; Hospitals, Pediatric; Humans; Infant; Male; Mercaptopurine; Methotrexate; Nutrition Disorders; Nutritional Status; Obesity; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Risk; Skinfold Thickness; Vincristine

Topics: Adrenocorticotropic Hormone; Atropine; Azathioprine; Colitis, Ulcerative; Crohn Disease; Diarrhea; Diet; Glucocorticoids; Humans; Immunosuppressive Agents; Mercaptopurine; Nutrition Disorders; Pain; Prednisolone; Prednisone; Sulfasalazine