We reviewed the records of 127 consecutive pediatric patients with acute lymphoblastic leukemia (ALL) to determine the incidence, timing, etiologies, and recurrence rate of seizures in this population. Patients with ALL and seizures were identified retrospectively by review of the records of all pediatric ALL patients who were diagnosed and treated during the years 1983 through March 1993 in a large tertiary-care hospital. Seventeen patients (13%) developed one or more seizures. In 16 patients, seizures occurred during antileukemic treatment, and in almost all of them seizures were related to intrathecal methotrexate (IT MTX) or subcutaneous L-asparaginase treatment. One patient who developed a seizure while not receiving chemotherapy had a history of cerebral infarctions. In 8 patients, (47%), the initial seizure episode was associated with a cerebral lesion. One or more seizures recurred in 6 patients. Four of these patients had an isolated recurrence, in 3 patients < or = 3 months and in 1 patient < or = 6 months after the initial event. Two patients (12%) with static encephalopathy and neurological deficits developed a chronic seizure disorder. There is a significant risk of acute symptomatic seizures in pediatric ALL patients. Most seizures in these patients occur during the acute treatment phase and are most frequently related to side effects of chemotherapy. The long-term recurrence risk is low; recurrence occurs most often in patients with evidence of cerebral structural lesions and neurological deficits. Long-term antiepileptic drug (AED) therapy should be restricted to such patients.

Transient myeloproliferative disorder (TMD) in newborns with Down syndrome (DS) has been well described. We report 4 newborns, 2 with DS and 2 without DS, who developed TMD. One newborn with DS developed multiorgan failure and died despite treatment with low-dose cytarabine. In 3 newborns, the TMD resolved spontaneously. Two of these patients, 1 with and 1 without DS developed leukemia on subsequent follow-up and were treated successfully. We reviewed the clinical and laboratory data on 14 non-DS infants with TMD reported in the literature. According to limited data, these patients are more likely to develop leukemia than DS patients, however their outcome is better.

The efficacy of antibiotic treatment of port-associated bloodstream infection without device removal has not been systematically studied. We analyzed the outcome of 43 consecutive portassociated bloodstream infections in pediatric hematology-oncology patients. Etiologies included Staphylococcus epidermidis (30) and Staphylococcus aureus (6). Antibiotics were given through the port for a median of 11 days. Four ports were removed within 72 hours. In 36 (92%) of the remaining 39 episodes, there was a response to antibiotic therapy (defervescence and negative blood culture). In 78% of episodes in which there was a response (excluding two in which the catheters were removed because of mechanical problems), the infections were cured without port removal. Two of the four relapses were cured with a second course of antibiotics. The cure rate was 92% for S. epidermidis infections and 67% for S. aureus infections. Thus, the majority of port-associated bloodstream infections in pediatric hematology-oncology patients can be cured without device removal.There are two types of surgically placed, subcutaneously tunneled Silastic (Dow Corning, Midland, MI) central venous catheters designed for long-term use. Broviac-or Hickmantype catheters exit through the skin after being passed through a subcutaneous tunnel, and totally implantable venous access ports ("ports") end in a subcutaneous reservoir after being passed through a subcutaneous tunnel (as, for example, with Mediport [Norfolk, Medina, NY] and Port-A-Cath [Pharmacia Deltec, St. Paul] ports). Ports are accessed by means of a special needle through intact skin. In pediatric oncology patients, ports are associated with a lower rate of catheterrelated bloodstream infection than are Broviac/Hickman catheters [1][2][3][4].Although cure of bloodstream infections related to nontunneled vascular catheters generally requires catheter removal, we and others have found that ϳ75% of Broviac/Hickman catheter-related bloodstream infections are cured without catheter removal [3][4][5][6]. In contrast, there are limited data concerning the efficacy of antibiotic treatment of port-associated bloodstream infection without port removal. To determine the advisability of initial antibiotic therapy without device removal, we studied the outcome of consecutive catheter-related bloodstream infections occurring in pediatric hematologyoncology patients with totally implantable venous access ports. MethodsPatient population. All pediatric hematology-oncology patients cared for at the Schneider Children's Hospital (New Hyde Park, NY) between 1 January 1991 and 31 December 1993 were identified through a log book of all patients seen by the division of pediatric hematology/oncology. Patients with a port were identified by review of the comprehensive flow sheets maintained for each patient by that division, on which data on all surgically placed vascular catheters, hospital admissions, infections, courses of antibiotic therapy, and vascular catheter removal are tabulated prospectively.To ensure that a...

No abstract

Six children with juvenile chronic myelocytic leukemia (JCML) with adverse prognostic features were treated with intensive combination chemotherapy similar to that utilized in patients with acute nonlymphocytic leukemia (ANLL). Despite obtaining hematologic remissions after induction therapy, clinical findings of extramedullary disease persisted. The use of intensive post-induction chemotherapy did not erradicate persistent extramedullary disease, and all patients developed hematologic relapse and progressive disease at a median of 8 months. The median survival of the treated patients was 15 months. The use of intensive ANLL therapy in poor prognosis JCML does not improve the survival rates reported with less intensive regimens but does have value in producing hematologic remissions that may be useful in preparing patients for bone marrow transplant.

No abstract

No abstract

No abstract