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In high-risk ALL, the rate of induction failure was high and boys had a worse outcome, calling for improvements in induction therapy and a specific approach for boys.

Korematsu S, Yamamoto K, Nagakura T, Miyahara H, Okazaki N, Akiyoshi K, Maeda T, Suenobu S-i, Izumi T. The indication and effectiveness of low-dose erythromycin therapy in pediatric patients with bronchial asthma. Pediatr Allergy Immunol 2010: 21: 489–492. © 2010 John Wiley & Sons A/STo elucidate the mechanisms of intractable pediatric bronchial asthma and the indication of low-dose erythromycin (EM) therapy, the serum chemokine levels of and the angiogenic factor were evaluated in 55 pediatric patients with bronchial asthma; 7.4 ± 3.5 yr old, who had been treated with inhaled steroid, leukotriene receptor antagonist, theophylline and others for more than a year. Both the levels of interleukin (IL) 8 (p = 0.036) and vascular endothelial growth factor (VEGF) (p = 0.005) were higher in patients with severe type than those of patients with the milder type, while other chemokine levels such as serum eotaxin and MCP1 did not show the correlation with the severity of bronchial asthma. Induction of therapy with low-dose EM induced improvement of the clinical symptoms in patients with severe type and decrease of their serum chemokine levels: IL8; from 736 ± 88 to 75 ± 85 pg/ml (p < 0.0005), and VEGF; from 352.0 ± 160.5 to 132.2 ± 59.9 pg/ml (p = 0.021) within the next 6 months. Moreover, low-dose EM resulted in a decreased daily peak-trough fluctuation rate of the serum theophylline concentration; (Cmax− Cmin)/Cmin, from 1.3 ± 0.5 to 0.5 ± 0.3, which led to the maintenance of effective serum levels. These results indicated that IL8 and VEGF affect the severity of standard therapies resistance intractable bronchial asthma. Through the suppression of these chemokines and maintenance of effective theophylline levels, low-dose EM therapy improves the symptoms of bronchial asthma.

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We analyzed the long-term outcome and late effects of treatment in 187 patients with childhood acute lymphoblastic leukemia (ALL) diagnosed between 1984 and 1990. Overall survival and event-free survival rates were 68.2% +/- 3.7% and 63.2% +/- 3.6% at 15 years, respectively. Of 55 patients who relapsed after achieving the first complete remission (CR), only 17.4% were rescued by salvage therapy. The advantage of stem cell transplantation over chemotherapy was observed only in those patients with bone marrow relapse during therapy. The SD for score height in patients maintaining the first CR significantly decreased at the time of final follow-up compared with that at diagnosis: 0.059 to -0.800 (P < .0001). The decrease was remarkable in patients younger than 5 years at diagnosis. Other late effects included mild liver dysfunction in 18% and hepatitis C virus infection in 9%. Congestive heart failure was observed in only 2.9% of patients despite the high cumulative dose of daunorubicin (450 mg/m2). Although the survival rates of patients on our protocols were comparable to those of other study groups, some modification, including reduction in dose of cranial irradiation and/or anticancer drugs, should be considered to reduce late adverse effects in survivors of childhood ALL.

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*Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. The two major histologic subtypes of RMS, embryonal and alveolar, have been found to have characteristic but distinct genetic alterations. Alveolar RMS has a much worse prognosis than the embryonal form. Metastatic RMS, especially the alveolar type, usually connotes a dismal outcome [1].Many markers and specific antibodies have been reported in RMS. However, to our knowledge, there has been no report that levels of lactate dehydrogenase (LDH) and creatine kinase (CK) correlate with systemic RMS. Our observations in three children with alveolar RMS with diffuse initial bone marrow involvement are therefore of interest.The first was a 10-year-old boy referred with pallor, fatigue, and anemia in May 1994. The blood count was as follows: hemoglobin 6.5 g/dl, platelet count 40 Â 10 9 /L, and white blood cell count 3.9 Â 10 9 /L. Other unusual laboratory findings were elevated LDH 4863 IU/L (200-370) and CK 344 IU/L (the normal range for males is 59-204). Bone marrow aspirate showed 94% of the nucleated cells were blasts, which were immunohistochemically positive for HHF35, desmin, and myoglobin. Subsequent studies including computed tomography of the nasopharynx identified a nasal tumor, which on biopsy proved to be RMS. Although the histologic subtype of RMS was unclear due to the small specimen, the presence of a characteristic translocation, t(2;13)(q35;q14), in the tumor cells strongly suggested the alveolar type [2].The second child was a 10-year-old girl with a 10-day history of bilateral gluteal pain in March 1996. The patient suddenly experienced paralysis of both lower legs and incontinence of urine and feces. On physical examination, two tumors on the scalp were found in addition to the right lower abdominal mass. Spinal magnetic resonance imaging studies revealed an extradural tumor extending from L4 to S1. An emergency operation included laminectomy at L5 and tumor resection. Histologic examination and an immunohistochemical study was positive for HHF-35 and myoglobin, and led to the diagnosis of alveolar RMS. The blood count was as follows: hemoglobin 9.4 g/dl, platelet count 295 Â 10 9 /L, and white blood cell count 8.4 Â 10 9 /L. The laboratory data revealed elevated serum LDH 1525 IU/L and CK 644 IU/L (the normal range for females is 41-154). Computed tomography of the abdomen showed an additional right parailiac mass that may have originated from the right ovary. The bone marrow aspirate showed that 33% of the nucleated cells were blasts with the characteristic t(2;13)(q35; q14) translocation. Molecular analysis of the bone marrow blasts revealed the characteristic chimeric PAX3/FKHR transcript.The third patient was a 6-year-old boy referred with a 13-day history of pain in both lower legs and easy bruising in January 1998. Physical examination revealed pallor, an enlarged right inguinal lymph node, and a right popliteal mass. The blood count was as follows: hemoglobin 9.1 g/dl, platelet count 79 Â 10 9 /L, and white blood cel...