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The clinical and immunological characteristics of lymphoid tumors were compared in 591 children with acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL). Comprehensive investigation of a tumor cell by using cytological, morphological, and immunological studies revealed the most significant criteria for differential diagnosis of ALL and NHL in children and showed the specific features of the site of a tumor and the extent of its growth in ALL and NHL in relation to the immunological affiliation of a tumor cell. The predominance of immature forms, such as stem-cell CD34+, pre-pre-B, pre-B and less commonly T-cell forms with almost none peripheral B- and T-cell markers could be immunophenotypically detected in ALL. NHL was, on the contrary, characterized by the prevalence of mature immunological subtypes with peripheral B- and T-cell markers and much less frequently pre-B and pre-T cells and at the same time there was no CD34 antigen in the tumor cells. Anaplastic giant lymphoma was a peculiar type of NHL characterized by the presence of large cells having marked anaplasia and expression on the surface of CD30 antigen. A comprehensive study of lymphoid tumors in children showed that immunophenotyping was of great value, whose results were associated with the specific feature of tumor growth and prognosis, which should be borne in mind while planning antitumor therapy programmes.

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Thirty eight children with large-cell anaplastic lymphomas have been recently treated at the Pediatric Department of Malignant Lymphomas, Russian Cancer Research Center, Russian Academy of Medical Sciences. Cytoimmunological studies have revealed that 24 patients had 4 types of cellular elements of large-cell anaplastic lymphoma: Kil(+), Kil(+)B, B-cell, and T-cell lymphomas in 11, 2, 8, and 3 children, respectively. Intensive chemotherapy was performed in relation to the immunophenotype.

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Differential diagnosis was established by complex morphological examination in 290 pediatric patients with Langerhans cell, sinus or malignant histiocytosis. An immunologic study was performed in one-third of patients. Clinical symptoms and results of therapy are presented.

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Treatment for mediastinal lymphosarcoma was given to 71 patients, aged 3-14 years, at the Institute's Clinics during 1982-1991. In that group, there were more males than females (3.4:1), mean duration of the condition of 3 months, T-cell immunity pattern (89.9%), enlarged anterior mediastinal lymph nodes and thymus, pleural lesions including pleuritis, mean mediastinal-thoracic index of 0.5, compression syndrome, elevated concentration of lactate dehydrogenase and presence of tumor cells in the bone marrow and peripheral blood. Among major negative factors of prognosis were inadequate therapy, pleural lesions and stage IV tumor.

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The high efficiency of treatment of lymphogranulomatosis in children by the currently available protocols determines the necessity of assessing them in terms of the quality of further life. The opportunity of creating a life and having the offspring, that of getting education and a profession are one of the main characteristics of the quality of life. The data on the reproductive function and social adaptation of 443 children receiving multimodality treatment for lymphogranulomatosis by 3 protocols (from 1976, 1978, and 1987). Two hundred and fifty eight individuals were 18 years old or more. Sixty four former patients have 88 children who are all healthy. The treatment performed in childhood intensively, which yielded a complete effect, exerts no substantial impact on the formation and performance of their reproductive function. The former patients have a high intellect, without limitations in getting professions, and they are easily adaptable to the changing social conditions.

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The course of histioproliferative diseases was analyzed in 308 children treated at the All-Union Cancer Research Center, USSR AMS. Of these, there were 8 children with benign proliferation (Rosai-Dorfman disease). Histiocytosis-X was revealed in 232 children. The authors describe the regularities of histiocytic proliferation manifestations depending on the patients' age. Provide morphological (cytological) criteria for different types of histioproliferative diseases and characterize the treatment data.

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Altogether 77 children aged up to 3 years with acute lymphoblastic leukemia (ALL) were examined for the immunological phenotype of blast cells. L1, L1/L2, L2/L1, L2 variants of ALL and the undifferentiated one were established in accordance with criteria of the FAB classification. T1, zero and Ia immunosubvariants were recorded most frequently. Mature cell T2 and pre-B variants (3 and 2 cases, respectively) were rare; B-cellular acute lymphoblastic leukemia was lacking; the "common" subvariant was revealed in 28 patients. The patients' age produced the highest effect on the prognosis: the significantly least disease standing and remissions were noted in a group of children under 2 years as compared to those aged 2 to 3 years. As for immunological markers, expression of Thy1-antigen exerted an unfavourable effect on the prognosis and duration of the first remission.

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The Soviet alpha-interferon drugs (human leukocytic interferon, reaferon) were used in the program of the treatment of children with acute lymphoblastic leukemia (during remission). The treatment was found to be more effective with an increase of its duration, relapse-free course of the disease (69.4-82.3%) and survival (70.1-93.1%) of patients with an unfavourable disease prognosis (over 5 years).

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Cases of lymphogranulomatosis underwent a clinico-morphological analysis in 67 children aged 1 year to 3 years 11 months. The morphological features of the process and distinctive traits of the clinical picture of the disease in infants were defined. The 5-year survival in patients undergoing the current treatment programs was estimated.

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The authors analyze the results of the treatment of 366 children afflicted with lymphogranulomatosis. All the patients received treatment from 1976 to 1990 according to three combined programs. The necessity is demonstrated of the individual treatment with regard to the predictors. Immunocorrection by means of taktivin was employed in patients with immunity disorders. The perfection of a complex of treatment measures favoured an increase of the survival to over 5 years in 93.8% of cases.

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The analysis of peculiarities of clinical course and morphology of malignant (acute) histiocytosis in 50 pediatric patients made a case for identification of the disease as separate pathology of histiocytic sarcoma type. Clinical course features include: lymphadenopathy, involvement of bones and--less frequently--lungs, skin and subcutaneous fat, marked fever and weight loss. Cytologic and histologic examination show polymorphic tumor cells of varying degree of differentiation, with blasts predominating. Well-developed Golgi complex, presence of lysosomes, phagosomes and erythrophagocytosis are among the characteristic ultrastructural features of the disease.

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Tolerability and efficacy of high-dose methotrexate was studied in 70 pediatric patients with lymphoblastic tumors (acute lymphoblastic leukemia and non-Hodgkin's lymphoma). Methotrexate was given by 24-hour infusion of 500-1000 mg/m2 (total dose-700-3000 mg) after remission had been achieved. An antidote--calcium folinate--was administered 24 hours postinfusion. Major adverse side-effects involved were stomatitis, hepatotoxicity and fever. Survival in the study group was higher than in controls.

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Correlation analysis of the clinical course and prognosis was made in 56 children with T-cell lymphoblastic tumors (acute lymphoblastic leukemia and lymphosarcoma) typed with the use of monoclonal antibodies obtained in this country. The frequency of T-cell marker detection among all immunological subvariants in acute lymphoid leukemia and lymphosarcoma proved to be similar (36.6 and 37%, respectively). In acute lymphoid leukemia type T1 of tumor cells prevailed (58%), while in lymphosarcoma type T3 (63%). T2 and T3-cell lymphoblastic tumors were characterized by the most severe clinical course.

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Data have been presented on the observation of 80 children with acute myeloid leukemia, among them 26 patients who, in addition to chemotherapy, were given tactivin treatment. The authors have proved the necessity of long-term tactivin administration in acute myeloid leukemia (no less than 2-3 years). that permits not only reducing the incidence of intercurrent diseases, but also increasing the duration of the remission period.

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The diagnostic value of monoclonal antibodies is discussed. The expression of ICO-GM1 and ICO-G2 myeloid antigens in pediatric patients with nonlymphoblastic leukemia was associated with poor prognosis whereas patients with the expression of T-cell markers fared better. The prognostic value of the antigens was not altered by brief cytotoxic treatment. The prognosis for non-T-cell ICO-II+ type childhood lymphosarcoma was worse as compared to Ia+ICO-II- lymphoma subset. It was concluded that the biology of malignant cells and degree of cell differentiation (as assessed immunologically) affects treatment outcome significantly and should be considered in individualizing therapy for childhood lymphosarcoma and leukemia.

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The age dependence of haemoglobin denaturation temperature in the composition of erythrocytes is established. Children have a much more expressed correlation of this temperature depending on the type and stage of disease than the adult. It is found that children ill with leukemia have haemoglobin, the value of heat denaturation of which is decreased about 15-25% in relation to the norm. Tests are created. They allow to reveal leukemia by heat parameters of haemoglobin denaturation of the whole blood.

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Soviet preparation of human leucocytic interferon (HLI) was injected to 112 children with acute lymphoblastic leukemia at different stages of the treatment program. The results obtained have evidenced that HLI produces a direct antitumor effect, intensifies the effectiveness of inductive chemotherapy and the treatment program leading to the prolongation of the remission period and survival of the patients, as well as induces activation of natural and antitumor resistance of the body.

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