RESUMEN
The objectives of this study was to investigate of the influences of high-dose (20 mg/kg/day) methyl prednisolone (HDMP) and granulocyte colony stimulating factor (G-CSF) in shortening the duration of chemotherapy-induced neutropenia encountered in children with ALL receiving maintenance therapy. Sixty-four non-febrile neutropenic attacks developed in 29 patients with ALL receiving St Jude XIII maintenance protocol were evaluated retrospectively. The patients were clinically followed up without drugs for shortening the duration of neutropenia in 21 (32.8%) attacs, while HDMP and G-CSF were administered in 26 (40.6%) and 17 (26.6%) attacks, respectively. After the detection of neutropenia, restoration of neutrophil counts at 2nd or 4th days to the levels that allow resuming the chemotherapy were considered as success. While second day and overall success rates in patients administered HDMP and G-CSF were significantly higher than the patients who were observed clinically. Both second day and overall neutrophil counts were significantly higher in patients administered G-CSF than the other groups. Methyl prednisolone and G-CSF treatments were well-tolerated by the patients. The cost-per neutropenic attack was significantly higher in G-CSF group than of the HDMP group. Especially in patients experiencing frequent neutropenic attacks and hence interruptions of the therapy, one of the myelopoiesis induction therapies can be used to shorten the duration of neutropenia. For this indication short-course HDMP therapy can be considered as an alternative to G-CSF in this patients due to its relatively low cost, amenability to outpatient administration, and well-tolerability by children.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Fiebre , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Metilprednisolona/uso terapéutico , Neutropenia/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neutropenia/sangre , Neutropenia/inducido químicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangre , Estudios RetrospectivosRESUMEN
Molluscum contagiosum is an infectious disease presenting with flesh-colored, dome-shaped, umblicated papules. A few atypical presentations have been reported in immunodeficient patients. A 5-year-old boy with acute lymphoblastic leukemia, presented with bright white-colored papular lesions with no umblications on the chin during his continuation chemotherapy. Increased number of the lesions covered almost his entire chin in months. Topical therapies did not improve the lesions. After his bone marrow relapse, induction chemotherapy was withheld because of bronchopneumonia after febrile neutropenia. After initiation of a combination of systemic parenteral antibiotic and antifungal therapies, his parents squeezed one of his papular lesions. Meanwhile, systemic acyclovir was added to his therapy, because of herpes labialis. Despite the large spectrum of his therapies, in 1.5 months, this small lesion progressed to a large lesion with erythematous ground and a central ulceration. Etiology of the lesion could not be enlightened until a skin biopsy that was compatible with the molluscum contagiosum. A partial resolution was achieved by cryotherapy. In conclusion, molluscum contagiosum may present as an ulcerating lesion during childhood leukemia treatment. A skin biopsy should be performed for the accurate diagnosis of atypical cutaneous lesions in immunocompromised patients.
Asunto(s)
Molusco Contagioso/etiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Úlcera/etiología , Preescolar , Humanos , Masculino , Molusco Contagioso/terapia , RecurrenciaRESUMEN
Vincristine is a commonly used antineoplastic drug and frequently causes neurotoxicity. Here the authors report a 4-year-old boy with acute lymphoblastic leukemia in whom vincristine-induced peripheral and cranial neuropathy developed during remission induction therapy. The patient seemed to benefit from pyridoxine and pyridostigmine therapy greatly and this therapy is recommended in patients with severe vincristine-induced neuropathy.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Inhibidores de la Colinesterasa/uso terapéutico , Enfermedades de los Nervios Craneales/tratamiento farmacológico , Fármacos Neuroprotectores/uso terapéutico , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamiento farmacológico , Bromuro de Piridostigmina/uso terapéutico , Piridoxina/uso terapéutico , Vincristina/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Transporte Axonal/efectos de los fármacos , Blefaroptosis/inducido químicamente , Blefaroptosis/tratamiento farmacológico , Preescolar , Terapia Combinada , Irradiación Craneana , Enfermedades de los Nervios Craneales/inducido químicamente , Epilepsia Tónico-Clónica/inducido químicamente , Trastornos Neurológicos de la Marcha/inducido químicamente , Trastornos Neurológicos de la Marcha/tratamiento farmacológico , Paro Cardíaco/inducido químicamente , Paro Cardíaco/terapia , Humanos , Masculino , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras B/radioterapia , Trastornos de la Sensación/inducido químicamente , Trastornos de la Sensación/tratamiento farmacológico , Inconsciencia/inducido químicamente , Vincristina/administración & dosificaciónRESUMEN
A 5-year-old girl in whom the diagnosis of inherited factor XIII deficiency was established at the age of 1 day presented with cryptic tonsillitis along with drowsiness and an abrupt occurrence of getting left interior cross eyed. While an intracranial hemorrhage was expected, cerebral imaging studies surprisingly revealed multiple sino venous thrombosis. In prothrombotic screening studies she and her father were both found to be heterozygous for factor V Leiden mutation along with having elevated levels of lipoprotein(a). Low-molecular-weight heparin was started. Ventriculoperitoneal shunt was applied because of persistence of increased intracranial pressure. Thrombosis disappeared and blood flow was normalized by the end of 2 months and the patient was discharged on coumadin therapy as being well. We would like to report this unusual case and to discuss the possible effects of two major genetic prothrombotic risk factors on inherited bleeding tendency or vice versa.
Asunto(s)
Factor V , Deficiencia del Factor XIII/complicaciones , Lipoproteína(a)/sangre , Trombosis del Seno Sagital/genética , Anticoagulantes/uso terapéutico , Angiografía Cerebral , Preescolar , Consanguinidad , Factor V/genética , Deficiencia del Factor XIII/genética , Femenino , Heterocigoto , Humanos , Trombosis del Seno Sagital/tratamiento farmacológico , Warfarina/uso terapéuticoRESUMEN
Corticosteroids, even in topical application, may cause immunosuppression and Cushing's syndrome. A case of disseminated fatal cytomegalovirus infection is reported in a 3-month-old girl with Cushing's syndrome caused by exogenous topical clobetasol propionate application, which might have caused immunosuppression due to prolonged use.