Search

Chemotherapy-induced neutropenia is a major dose-limiting side effect of intensive chemotherapy in cancer patients. Recently, pegfilgrastim (a product with a long half-life, resulting in once-per-cycle dosage) was introduced to prevent neutropenia in adults. The authors report 32 episodes of pegfilgrastim use in seven pediatric cancer patients to diminish chemotherapy-induced neutropenia. Feasibility was assessed by adherence to treatment protocol and safety was assessed by adverse effects. There were only two treatment delays (6%) due to neutropenia. No short-term adverse effects were recorded. The use of pegfilgrastim is feasible in pediatric cancer patients, without short-term adverse effects or major treatment delay due to neutropenia.

Treatment of Hodgkin disease (HD) in ataxia telangiectasia (AT) patients is hampered by hypersensitivity to radiation and chemotherapy. Most patients die, due to toxicity or rarely, to progressive disease. The authors report on a 9-year-old girl with stage IIA HD and AT She was treated with a tailored combined modality approach. No unacceptable toxicity was found, but the girl died of a relapse outside the irradiation field. In comparison with fibroblasts of non-AT patients, the fibroblasts of the patient were 3 times as sensitive for radiotherapy but just 1.2 times as sensitive for doxorubicin. A good correlation was shown between in vitro radio and chemosensitivity testing and the observed clinical toxicity. The authors suggest, therefore, treating AT patients as much as possible according to standard protocols by adjusting the radiotherapy delivery and the chemotherapy regimen to individual doses derived from in vitro radio and chemosensitivity testing.

Because controversy exists about the growth inhibiting effect of chemotherapy, we studied up to 4 years after diagnosis, height, growth and bone age de development in 28 children treated with cytostatic drugs for a solid tumor or Langerhans cell histiocytosis. The results were compared with those previously published of 40 children with acute lymphoblastic leukaemia (ALL), treated according to 3 different regimes: 2 regimes included cranial irradiation (18-24 Gy), while all 3 regimes included intermittent steroid treatment during continuation treatment. The non-ALL patients showed no significant changes of bone age development or height growth. However, in ALL patients height growth and bone age development were retarded during therapy with a catch-up for height and bone age development after completion of chemotherapy. We conclude that cytostatic drugs in the dosages used do not have significant growth inhibitory effect; however, they may inhibit catch-up growth during intermittent short term corticosteroid treatment.