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Background: The prevalence of seizures in children with acute lymphoblastic leukemia (ALL) varies between 3 and 13% depending on the various studies, whereas it is 1% in the general population aged under 15 years etiopathogenesis and outcome of seizures in children during treatment for ALL., Methods: A retrospective study was carried out in 204 children with a consecutive diagnosis of ALL, 89 females and 115 males, aged between 5 months and 17 years and 11 months, diagnosed between 15-4-1988 and 15-4-1998, and treated at the Division of Pediatric Oncology and Pediatric Hematology of Turin University using three successive generations of AIEOP protocols 88 (48 cases), 91 (86 cases) and 95 (70 cases). Observation of the patients in the study ended on 30-9-1998. The criteria for eligibility were those stated in the respective protocols. Seizures were classified using the international classification; the diagnosis was made if a doctor, a nurse or a reliable relative witnessed the event with confirmation by the consultant neurologist., Results: Twelve out of 204 (5.8%) patients in this series presented seizures: 2 out of 48 cases using protocol 88 (4.1%), 6 out of 86 cases using protocol 91 (6.9%) and 4 out of 70 cases using protocol 95 (5.7%). None of the patients had critical episodes or other significant neurological pathologies prior to the onset of ALL, nor had they been affected by leukemic meningosis or undergone cranial radiotherapy. When evaluating the possible etiology, the authors noted that, except for one case of febrile convulsion, the seizures in the remaining patients could be attributed to the toxicity of chemotherapy. With regard to the evolution of seizures, only one patient died, whereas the others showed no neurologic sequelae., Conclusions: The frequency of seizures in children receiving treatment for ALL in the series analysed here is in line with that reported in the literature. Neurotoxicity caused by chemotherapy appears to be the main etiopathogenetic factor.

Background and Aims: Sporting activities and periods of convalescence call for an added intake of nutrients in children. This study aimed to evaluate the effect of a natural vitamin supplement on diet, food intake, body composition and muscular strength in children during convalescence and in children practising sports., Methods: A comparative study was performed in two different groups of subjects: 20 children aged between 6 and 12 years old during convalescence following infections of upper airways, and 20 9-year-old children forming part of a football team. All subjects were randomly subdivided into two groups who were respectively given a vitamin supplement (Vitality Roeder 2000 Junior) or a placebo for 4 weeks. Weight, body composition using and muscolar strength using dynamometer measured before and after the study and a food diary was kept for 3 days before each visit., Results: No significant differences in body mass and strength emerged from the data collected in the athletic group, whereas an increase was observed in appetite, calorie intake, weight and muscular strength in the convalescent group (p < 0.05). A significant increase in vitamin B12, B3, B5 and D levels was observed in both groups., Conclusions: The supplement to provides an adequate intake for those categories at risk of vitamin deficiency or in conditions of increased requirements.

Background: As previous studies demonstrated, free polyamines (putrescine, spermidine and spermine) are increased in neoplastic tissue and in body fluid (blood, urine and spinal fluid) of patients with tumours in various localization. In pediatric oncology, there aren't many specific markers useful to screen subjects at risk of developing cancer or to follow-up after treatment. For these reasons, polyamines' levels in plasma and erythrocytes have been evaluated in three groups of patients: healthy, with acute leukemia and with solid tumour., Methods: Polyamines' content has been determined on samples of blood, previously dansylated, by HPLC (high performance liquid chromatography)., Results: The results of this study show that putrescine is decreased in plasma of patients with acute leukemia and with solid tumours. The difference, even if more important in subjects with leukemia, is significant in both groups. Spermidine instead, shows an increase, but only in patients with solid tumour. Erythrocyte assays reveal a significant decrease of spermidine in subjects with acute leukemia with consequent inversion of spermidine/spermine ratio. In erythrocytes there aren't any other significant changes in relation to the levels observed in healthy patients. Polyamine assay, especially that of putrescine and spermidine in plasma, could be propounded as a marker for pediatric neoplasms., Conclusions: Moreover, as it is well-known, pediatric neoplasms lead to alterations of polyamine metabolism, because the synthesis and catabolism of these molecules is closely involved in tumoral growth. Consequently, inhibitors of polyamine synthesis could be used with success in antineoplastic chemotherapy.

Age is an important prognostic factor in acute childhood lymphoblastic leukemia (ALL): intermediate age children (1-9 years) show a better outcome than infants (0-1 year) and adolescents (10-15 years). However recent literature data do not agree about adolescents worse prognosis. We tried to contribute to this issue with a retrospective analysis about presenting features and survival of 302 pediatric patients (65 adolescents and 237 children) with non B ALL enrolled on AIEOP protocols at the Departments of Pediatric Haematology-Oncology (University of Turin) from 1976 to 1992. The last follow up was 30.11.94. We found in adolescents, in spite of higher frequency of unfavourable prognostic factors (Hb > 8 g/dl, mediastinal mass, T cell immunophenotype, L2 morphology), an event free survival similar to children (EFS 52% vs 51%). In conclusion in our population we found that age at diagnosis greater than 10 years does not represent an unfavorable prognostic factor.

Multidrug resistance represents one of the most important factors that may lead to a therapeutic failure in some patients affected by malignancies. One of the best known mechanisms is linked to the genic amplification or the overproduction of a membrane glycoprotein, GP170, that is the product of the gene MDR1. The existence of drugs (calcium blockers, cyclosporine, tamoxifen, reserpine, quinidine) able to bind themselves to gp170 and to paralyze its activity in vitro is well known. We studied 20 pediatric patients (median age 9 years) affected by acute lymphoblastic leukemia (ALL), osteosarcoma, neuroblastoma and medulloblastoma, in advanced stage of disease. We employed in all cases the association of cytostatics with verapamil (50-70 mg/m2 i.v.) and cyclosporine (5-8 mg/kg i.v.) with different infusion schedules. In leukemias we administered vincristine (1.5 mg/m2), and daunomycin (40 mg/m2), in solid tumors VP16 (150 mg/m2) and adriamycin (60 mg/m2). Seventy-two therapeutic courses were performed: 39 in ALL, 16 in osteosarcoma, 16 in neuroblastoma and 1 in medulloblastoma. On the whole 5 complete remissions were achieved in ALL patients and 1 in an osteosarcoma patient. We did not observe a significant myelosuppression during treatment, therefore few infectious complications occurred; furthermore electrocardiographic changes have been mild and promptly resolved after temporary discontinuation of verapamil infusion. Our data suggest a synergy of verapamil and cyclosporine in the inhibition of multidrug resistance induced by gp170, without the occurrence of heavy toxicity. The results obtained in ALL patients are encouraging., especially in view of a possible subsequent bone marrow transplantation, while in solid tumors they are not as satisfying.

The case of a child treated for Acute Lymphoblastic Leukemia (LLA) with high-dose L-asparaginase, (HD L-ase) presented alteration who of lipidemic values (rise of total cholesterol and triglyceride values) without toxicity is described. This finding has previously been reported in only a few patients. Parameters normalized with dietetic regimen. The authors underline the importance of the control, in patient during HD L-ase treatment of lipidic values too, especially when parents also have similar alterations.

Pulmonary toxicity occurs in approximately 10 to 50% of patients undergoing bone marrow transplantation (BMT). Bacterial pneumonia very commonly affects patients within the first 6 months post-BMT. Etiologic factors include neutropenia and the presence of graft-versus-host disease (GVHD). Pulmonary fungal infections, due to candida and aspergillus, may develop in 16% of patients receiving BMT, with a high mortality rate, being about 80%. A prolonged neutropenia as well as GVHD and associated immunosuppressive treatments are important factors in predisposing a patient to develop fungal pneumonitis. Interstitial pneumonitis occurs in 10-40% of patients; herpes viruses are the most commonly documented cause, with cytomegalovirus (CMV) being the most common pathogen. No causative organism is identified in up to 60% of the cases. It is likely that some of these cases may result from drug or radiation toxicity. Lung shielding and fractionation of the dose have decreased the incidence of interstitial pneumonitis to less than 5%. Patients with GVHD are predisposed to lung infections because of the immunosuppression that accompanies GVHD and its treatment. In addition, GVHD itself appears to have a direct effect on pulmonary epithelium. Cultural and serologic studies as well as radiographic investigations and other diagnostic procedures (ie bronchoalveolar lavage) are needed for appropriate management of pulmonary complications.

Only in these latest years has been possible to consider Hodgkin disease (HD) as a neoplastic syndrome, thank of immunohistochemistry and cytogenetic techniques which have confirmed the monoclonal origin of typical cellular marker of disease: the Reed-Sternberg cell (R-S cell). Interesting associations have been observed between children suffering from HD and the positivity of EBV antigen above all in the socio-economically developed countries. The histopathologic classification of HD is divided in four sub-types, with different incidence in the pediatric age: the nodular sclerosis and the mixed cellularity are more rap-presented than the lymphocyte predominance and mostly the lymphocyte depletion. Histopathologic classification is essential for the prognosis and a correct therapeutic approach to disease. The management of HD is based on chemotherapy and radiotherapy associated; the results of treatment are more and more encouraging with a global survival over 95%. Sequelae of treatment are reduced in modern therapeutic trials: in particularly injury to somatic growth, cardiopulmonary system, gonadal and thyroid functionality is reduced by using low dose and involved fields for the early stage patients. The most important sequela in children treated for HD is the risk to developed a second malignant neoplasm; in particularly acute nonlymphocytic leukemia and non Hodgkin's lymphoma. In patients treated with radiotherapy alone increase the risk to develop solid tumors like sarcomas and carcinomas, which can appears several years after diagnosis.

The gastrointestinal tract is an uncommon site of presentation for acute lymphoblastic leukemia in children. We report a child who developed a leukemia-lymphoma syndrome with central nervous system and gastrointestinal tract involvement at the diagnosis. The patient received an intensive combination chemotherapy and is currently off-therapy in continuous complete remission 29 months after the diagnosis.

Twenty-seven pediatric patients (less than 13 years of age) with inoperable primary brain tumors, treated with combined radiotherapy and chemotherapy or radiotherapy alone between January 1976 and December 1987 have been reviewed. Overall survival for all patients and for patients with brain-stem tumors was 49% and 43%, respectively. An increased risk of infection was associated with adjuvant chemotherapy. However, there were no toxicity that resulted in death.