RESUMO
Chemotherapy-induced oral mucositis is a frequent therapeutic challenge in cancer patients. The purpose of this retrospective study was to estimate the prevalence and risk factors of oral mucositis in 169 acute lymphoblastic leukaemia (ALL) patients treated according to different chemotherapeutic trials at the Darcy Vargas Children's Hospital from 1994 to 2005. Demographic data, clinical history, chemotherapeutic treatment and patients' follow-up were recorded. The association of oral mucositis with age, gender, leucocyte counts at diagnosis and treatment was assessed by the chi-squared test and multivariate regression analysis. Seventy-seven ALL patients (46%) developed oral mucositis during the treatment. Patient age (P = 0.33), gender (P = 0.08) and leucocyte counts at diagnosis (P = 0.34) showed no correlation with the occurrence of oral mucositis. Multivariate regression analysis showed a significant risk for oral mucositis (P = 0.009) for ALL patients treated according to the ALL-BFM-95 protocol. These results strongly suggest the greater stomatotoxic effect of the ALL-BFM-95 trial when compared with Brazilian trials. We concluded that chemotherapy-induced oral mucositis should be systematically analysed prospectively in specialized centres for ALL treatment to establish the degree of toxicity of chemotherapeutic drugs and to improve the quality of life of patients based on more effective therapeutic and prophylactic approaches for prevention of its occurrence.
Assuntos
Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Estomatite/epidemiologia , Adolescente , Fatores Etários , Antibióticos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Antineoplásicos Alquilantes/administração & dosagem , Antineoplásicos Hormonais/administração & dosagem , Antineoplásicos Fitogênicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Asparaginase/uso terapêutico , Brasil/epidemiologia , Criança , Pré-Escolar , Ciclofosfamida/uso terapêutico , Citarabina/uso terapêutico , Daunorrubicina/uso terapêutico , Feminino , Seguimentos , Humanos , Lactente , Contagem de Leucócitos , Masculino , Mercaptopurina/uso terapêutico , Prednisolona/uso terapêutico , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Vincristina/uso terapêuticoRESUMO
Between November 1986 and July 1988, 21 consecutively diagnosed children with nonlocalized abdominal lymphoma (Murphy's stage III and IV without CNS disease) were eligible for treatment with a multidrug chemotherapy schedule. The induction phase was the same for all (fractionated cyclophosphamide, intermedian-dose methotrexate [Mtx], vincristine [Vcr], and prednisone). After that the children were randomized to repeat the same scheme or intercalate teniposide (VM26) plus cytarabine (AraC) with the induction-phase scheme. All of them were treated for only 6 months. The protocol approved to be very effective with 85% remission in all the children and 94% survival in patients surviving the induction phase. The toxicity was acceptable, also considering the characteristics of our population (malnourished children). The group VM26 and AraC had few hospital admissions in spite of the small number of children because they received VM26 and AraC as outpatients. The sale purpose of the present study is to report that with a few simple procedures such as hydration, alkalinization, and drug fractionation, the chemotherapy schemes used can bring about a dramatic improvement in short-term survival.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma não Hodgkin/tratamento farmacológico , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Criança , Pré-Escolar , Ciclofosfamida/administração & dosagem , Daunorrubicina/administração & dosagem , Feminino , Humanos , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/patologia , Masculino , Metotrexato/administração & dosagem , Estadiamento de Neoplasias , Prednisona/administração & dosagem , Pré-Medicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Taxa de Sobrevida , Vincristina/administração & dosagemRESUMO
The results of therapy given to 74 children with advanced disease, abdominal non-Hodgkin's lymphoma were retrospectively evaluated with respect to the major prognostic factors related to disease outcome. The first 36 patients admitted in the study were treated with a modified LSA2-L2 protocol, and the remaining patients received the same regimen with the addition of intermediate-dose methotrexate (MTX) intravenously during the induction phase (LSA2-L2-MTX). The last ten patients admitted were given a leucovorin rescue along with the administration of MTX. The relative efficacy of the LSA2-L2-MTX over the baseline LSA2-L2 regimen was analyzed by multivariate statistical methods taking into consideration several candidate coprognostic factors. The risk of treatment failure was substantially reduced (55%) with the use of the LSA2-L2-MTX regimen. Rescue with leucovorin did not contribute a further significant gain in treatment efficacy, although fewer toxicity-related problems were observed as compared to the no-rescue period. Five prognostic factors emerged as significantly explanatory of the risk of treatment failure in addition to protocol type: lymphocyte count, disease stage, surgical debulking, sex, and nutritional status. Based on these variables, a logistic regression equation could be derived to identify groups that were at risk for treatment failure.
Assuntos
Neoplasias Abdominais/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Adolescente , Contagem de Células Sanguíneas , Carmustina/administração & dosagem , Criança , Pré-Escolar , Ciclofosfamida/administração & dosagem , Daunorrubicina/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Linfoma não Hodgkin/tratamento farmacológico , Masculino , Metotrexato/administração & dosagem , Estado Nutricional , Prednisona/administração & dosagem , Prognóstico , Fatores de Tempo , Vincristina/administração & dosagemRESUMO
Despite the tremendous progress that pediatric oncology has achieved in the treatment of Wilms' tumor over the last several decades, survival rates in our institution before 1970 did not exceed 8%. In order to correct the problem standardized therapy was instituted in 1970 through a multimodal oncological team. Results using the new approach were reviewed in 1979 (50 patients) and showed an overall 34% 2-year survival rate. Although encouraging, these results were still far below the ones reported in the literature. This prompted us to use a vigorous professional and lay educational program in the city. Treatment methods were replaced by those advocated by the Second National Wilms' Tumor Study. A second evaluation period initiated in 1979 and extended through 1984 (35 patients) yielded an overall 83% survival rate. A retrospective study of the two periods by univariate and multivariate survival analysis revealed that, although much of the improvement in survival could be attributed to a shift in stage distribution towards earlier disease, the admission period itself had an important additional explanatory effect with respect to survival. This was probably due to the improvement in treatment protocols used in the latter period. Age was a prognostic variable only for patients admitted during the 1979-1984 period.
Assuntos
Países em Desenvolvimento , Neoplasias Renais/terapia , Tumor de Wilms/terapia , Análise Atuarial , Brasil , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Estadiamento de Neoplasias , Análise de Regressão , Estudos Retrospectivos , Tumor de Wilms/mortalidade , Tumor de Wilms/patologiaRESUMO
Os autores descrevem um caso com diagnóstico de linfoma näo-Hodgkin (Burkitt) cujas manifestaçöes oculares foram as típicas de uma leucemia linfocítica aguda e discutem clinicamente os critérios de classificaçäo destas patologias