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In children and young adults, aggressive therapy is required in the treatment of acute nonlymphocytic leukemia. This usually means not only intensive induction therapy to induce remission in as many patients as possible, but also aggressive intensification therapy for the patients who do achieve remission. In a study of the timing of the intensification therapy in patients achieving remission, earlier aggressive intensification was demonstrated to be more effective. A total of 194 patients were treated for acute nonlymphocytic leukemia with two- to five-drug induction regimens, which are limited by bone marrow toxicity. One hundred thirty-four patients achieved remission; the 104 patients for whom bone marrow donors were not available and who were not lost to follow-up began intensification treatment with araC (cytarabine or cytosine arabinoside) either 7 or 28 days after induction. At 28 days, the blood is recovering from the induction chemotherapy, while at 7 days the blood counts are still dropping. After the araC intensification, patients were either placed on maintenance therapy or not, at the discretion of their individual physicians. Despite three treatment-related deaths in the seven-day group, that is, the ''aggressive'' treatment group, the three-year disease-free survival was 55 percent, compared with 42 percent for the 28-day group (the overall survival for the aggressive group was 64 percent). The decision on whether to provide maintenance therapy had no significant impact on survival among the patients receiving the aggressive araC treatment. However, among the patients on the more conservative 28-day araC intensification schedule, a three-year survival of 65 percent was observed in the group receiving maintenance therapy, in contrast with 39 percent in the group without maintenance. The results indicate that timing is an important aspect of intensification therapy, and that with aggressive intensification in the treatment of acute nonlymphocytic leukemia, maintenance therapy may provide no additional benefit. (Consumer Summary produced by Reliance Medical Information, Inc.)

Polyarteritis nodosa (PAN) may be rare in children but detectable in biopsied tissue containing dead fibrous tissue and inflamed muscle arteries. A 12-year-old boy was diagnosed with PAN after failed antibiotic therapy to treat sore throat, fever, and a neck mass. The diagnosis of PAN was confirmed by results of a skin biopsy from a foot, which showed inflamed muscle arteries and dead tissue. There may be a connection between group A streptococcal infection and PAN in children. Treatment with corticosteroids and cyclophosphamide has decreased the death rate from PAN to under 20%.