Klinische Pädiatrie
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Klinische Pädiatrie · Nov 2004
Comparative StudyBone marrow oedema and aseptic osteonecrosis in children and adolescents with acute lymphoblastic leukaemia or non-Hodgkin-lymphoma treated with hyperbaric-oxygen-therapy (HBO): an approach to cure? -- BME/AON and hyperbaric oxygen therapy as a treatment modality.
There is a striking need for additional therapies of bone marrow oedema (BME) and aseptic osteonecrosis (AON) in paediatric oncology patients. Hyperbaric oxygenation (HBO) therapy used in the treatment of osteoradionecrosis is demonstrated effectiveness. Aim of this retrospective analysis was to investigate whether HBO-therapy might lead to subjective as well as objective effects in the treatment of BME and/or AON in paediatric oncology patients with acute lymphoblastic leukaemia (ALL) or Non-Hodgkin lymphoma (NHL). ⋯ Children and adolescents diagnosed with ALL or NHL have a risk for accruement of BME and/or AON irrespective of the age, with an almost exclusive involvement of the lower extremities. Lesions of pedal bones and ankle joints predominantly affect children < 10 years. Lesions of knee and hip joints predominantly affect children > 10 years. In children < 10 years of age we demonstrate declining AON numbers and conversion of AON to BME thereby implicating possible beneficial effect of HBO in such patients. HBO failed to show beneficial effect on BME whether by preventing new lesions or by improving existent lesions in children > 10 years.
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Klinische Pädiatrie · Nov 2004
Multicenter Study Comparative Study Clinical TrialLow grade chiasmatic-hypothalamic glioma-carboplatin and vincristin chemotherapy effectively defers radiotherapy within a comprehensive treatment strategy -- report from the multicenter treatment study for children and adolescents with a low grade glioma -- HIT-LGG 1996 -- of the Society of Pediatric Oncology and Hematology (GPOH).
Low grade gliomas arise in all CNS-locations and age groups, chiasmatic-hypothalamic tumors occur especially in young children. Early radiotherapy (RT) shall be deferred by chemotherapy (CT) within the concept of the HIT-LGG 1996 study, offering a comprehensive treatment strategy for all age groups. ⋯ Within the comprehensive treatment strategy for low grade glioma HIT-LGG 1996 chemotherapy is effective to delay the need for early radiotherapy in chiasmatic-hypothalamic glioma. More effective reduction of the risk for progression has to be sought for young children < 1 year.
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Klinische Pädiatrie · Nov 2004
Comparative StudyTransplantation of haematopoietic stem cells derived from cord blood, bone marrow or peripheral blood: a single centre matched-pair analysis in a heterogeneous risk population.
Beside the transplantation of haematopoietic stem cells derived from bone marrow (BMT) and peripheral blood (PBSCT) in the absence of a well-matched donor, transplantation of cord blood (CBT) has been shown to be a valid alternative. To validate the efficacy of CBT in comparison to BMT and PBSCT we performed a single-centre based matched-pair analysis. ⋯ Transplantation of < or = 4/6 HLA-matched CB grafts seems to be associated with a higher risk of GvHD, graft rejection and lethal opportunistic infection. With an overall survival of 53 % in our 15 patients this analysis documents that even in high risk patients, CB may be a valid alternate HSC source in children who lack a well-matched donor. This is especially true, if a > 4/6 HLA-matched CB with > 2.0 x 10 (7) total nucleated cells/kg bodyweight is available. Thus, parallel to the search for a BM or PBSC donor, searching for an adequate CB unit should be initiated.