mercaptopurine and Spinal-Cord-Neoplasms

The progressive improvement in the prognosis of acute lymphocytic leukemia has been a result of two major developments: 1) the more efficient use of chemotherapeutic agents, particularly the use of combinations of agents and the discovery that agents effective at one stage of disease may be inappropriate at another stage, and 2) the prevention with irradiation of central nervous system relapse. As many as one-half of children with this disease may enjoy long-term leukemia-free survival. However, further studies are needed to improve the efficacy and reduce the toxicity of therapy. This paper reviews the evolution of some of these studies.

Topics: Age Factors; Antineoplastic Agents; Asparaginase; Brain Neoplasms; Child; Child, Preschool; Cyclophosphamide; Cytarabine; Daunorubicin; Drug Therapy, Combination; Female; Humans; Leukemia, Lymphoid; Male; Mercaptopurine; Methotrexate; Prednisone; Radiotherapy; Remission, Spontaneous; Spinal Cord Neoplasms; Vincristine

Topics: Adolescent; Adult; Blood Transfusion, Autologous; Brain Neoplasms; Child; Child, Preschool; Cobalt Isotopes; Cyclophosphamide; Female; Humans; Infant; Infections; Injections, Intravenous; Leukemia, Lymphoid; Male; Mercaptopurine; Methotrexate; Radiation Dosage; Radiation Effects; Remission, Spontaneous; Spinal Cord Neoplasms; Time Factors

Twenty-one patients with recurrent malignant central nervous system gliomas were treated with a combination of 5-fluorouracil, CCNU, hydroxyurea, and 6-mercaptopurine. Thirteen patients had brain stem gliomas, 3 patients had spinal cord gliomas, 3 patients had thalamic gliomas, and 2 patients had cerebellar astrocytomas. All patients had received radiation therapy, and 4 brain stem patients had also been treated with chemotherapy. Sixteen patients (76%) responded to treatment with either stabilization of disease or improvement. Nine of the 13 patients with brain stem gliomas (71%) had response or stabilization of disease. The median time to tumor progression (TTP) for the brain stem patients who responded or had stabilization of disease was 25 weeks. The median survival from recurrence for the brain stem glioma patients was 27 weeks. Patients with cerebellar, thalamic, and spinal cord tumors did very well, with an 87% response or stabilization of disease and a median TTP of 122 weeks.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Brain Stem; Child; Child, Preschool; Ependymoma; Female; Fluorouracil; Glioma; Humans; Hydroxyurea; Lomustine; Male; Mercaptopurine; Neoplasm Recurrence, Local; Spinal Cord Neoplasms

This report describes the results of a study of central nervous system (CNS) prophylaxis and combination chemotherapy for the maintenance of remission in adult acute lymphoblastic leukemia. Adults with acute lymphoblastic leukemia who achieved complete remission were treated with 2,400 rads cranial irradiation and intrathecal methotrexate for CNS prophylaxis followed by continuation systemic chemotherapy with oral methotrexate, 6-mercaptopurine and cyclophosphamide. There were no CNS relapses following treatment. One-half of the patients relapsed within 11 months, with 5 patients remaining in remission for 27+ to 31+ months. The toxicity was acceptable with no treatment-related deaths. This regimen is capable of producing long remissions in a significant proportion of adults with acute lymphoblastic leukemia and appears to be effective in reducing the incidence of CNS relapse. It has the additional advantage of ease of administration and can be largely administered in the community.

Topics: Adolescent; Adult; Brain Neoplasms; Cyclophosphamide; Female; Head; Humans; Leukemia, Lymphoid; Male; Mercaptopurine; Methotrexate; Middle Aged; Remission, Spontaneous; Spinal Cord Neoplasms

Topics: Adolescent; Child; Child, Preschool; Cyclophosphamide; Dactinomycin; Female; Humans; Infant; Leukemia; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Paraplegia; Prednisolone; Retroperitoneal Neoplasms; Sarcoma, Ewing; Spinal Cord Neoplasms; Vinblastine; Vincristine; Wilms Tumor