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Clinical application of glycoproteins stimulating the growth (G-CSF), differentiation and activity of the cells of granulocyte line has become a landmark in the treatment of patients with neutropenia. It has been proved that filgrastim (rHU G-CSF) applied after intensive chemotherapy shortens the duration of neutropenia and decreases the frequency of occurrence of infections. The paper discusses the efficiency and tolerance of filgrastim in children treated for NHL. Filgrastim was applied in children with NHL T cell and B cell treated according to BFM 86 protocols. It was given in a dose of 5 micrograms/kg daily i.v. The duration of therapy ranged from 5-20 days. Altogether 47 cycles were performed. 25 cycles were performed in 12 children during granulocytopenia (< 1 x 10(9)/l). The median time of neutropenia recovery, the frequency of severe infection and chemotherapy retardation were significantly lower in the examined than in the control group (p < 0.05). In 6 children 22 courses of filgrastim were given prophylactically after the cycles of intensive chemotherapy of NHL. Only during two courses due to neutropenia the chemotherapy retardation was necessary. Toleration of filgrastim was good. Application of filgrastim right after the intensive chemotherapy in children with NHL has considerably improved persistent realization of treatment programmes. Tolerance of the drug was good.

15 children with ALL and chemotherapy related neutropenia were treated with GM-CSF (Leucomax-Sandoz/Schering-Plough) in a dose of 5 micrograms/kg b.w./day during 7-10 days. Altogether 21 cycles were performed. Increase in the number of neutrophils in the majority of cases was observed already after 3 days of GM-CSF administration. The median time of neutropenia recovery was shorter in children treated with GM-CSF than in the control group. The frequency of severe infections was also significantly lower. No serous side effects were observed.

The course of the hepatitis B virus infection (HBV) in the majority of children with cancer who have undergone intensive chemotherapy is characterized by scanty symptoms and often leads to chronic hepatitis and prolonged carrier state. Twenty three children with chronic hepatitis B virus (HBV) were treated with interferon alfa after the completion of chemotherapy of leukemias and lymphomas. In the majority of cases a disproportion between symptomless clinical course of the hepatitis B virus and the rate of its active replication was observed. Presence of HBsAg and high activity of polymerase DNA HBV (pDNA) were found in all children. In the course of a 6-month treatment with interferon in a dose of 3 mil IU/m2 of the body surface a gradual decrease of pDNA activity was observed. A statistically significant difference of mean values of pDNA before and right after the treatment was determined (p < 0.05). Tests performed 3 months after the completion of the therapy showed a repeated increase of pDNA activity. Boundary values of pDNA were observed in 5 children. Complete elimination of HBs and HBe antigens has not been achieved in any of the children. While analyzing the obtained results it has to be taken into consideration that there were numerous unfavourable prognostic factors determined in the studied group of children such as: coexisting malignant disease, undergone intensive chemotherapy, long period which has passed from the moment of HBV infection until the administration of the treatment with interferon, high activity of pDNA, scanty symptoms of inflammation process. Coexisting HCV infection in 12 children, could also have a undesirable effect upon the treatment results.(ABSTRACT TRUNCATED AT 250 WORDS)

Retrospective analysis of the results of treatment chronic myeloid (CML) leukemia in 80 children was done. From among 72 children treated by conventional methods the probability of 10 years survival had 17%. Statistically significant better results was obtained in the group of children with adult than juvenile type of CML (23 and 8%). Allogenic bone marrow transplantation was performed in six children, two children were treated with interferon. New approaches of treatment may offer the better chance for constitution of normal bone marrow function.

In the group of 63 children in whom a relapse of ALL after first suspension of treatment occurred, and in whom a repeated cessation of therapy had place, 46.2% of patients had probability of a prolonged symptomless survival. The children with an isolated extramedullary relapse had a greater chance for a DFS of 7 years, than those with a relapse in the bone marrow (p = 0.05). The patients with a relapse occurring after the first cessation of treatment of ALL should be treated as intensively as newly diagnosed cases, because they have a real possibility for a prolonged survival during remission phase of disease.

Among 1879 children with the diagnosis of acute lymphoblastic leukaemia made up to Dec 31 1987 in 863 cases (45.92%) treatment was discontinued. They were followed up till Dec 31 1989. The median follow-up was 3 years and 14 months. In 811 cases the treatment was discontinued during the first complete remission, in 56 cases after a relapse during initial treatment. In the time period when the programmes St. Jude and LSA2L2 were used the per cent of children with treatment withdrawal was 38.22%, but it rose to 53.01% when a more intensive programme BMF had been introduced. The probability of 7-year disease free survival after treatment discontinuation was 69.5% and 76.2% respectively. In 186 cases (21.6%) relapses developed., mostly in the first year after treatment discontinuation, but even after 7 years the risk of relapse was 2.46%. Ninety-six children (11.2%) died, 761 (88.8%) are alive, among them 671 in the first complete remission. Apart from therapy intensity, a statistically significant beneficial effect on disease free survival had discontinuation of treatment during the first complete remission, and sex--the prognosis was better in girls. In three cases secondary neoplasms were found.

In the time period from February to October 1988 the indicators of hepatitis virus B infection, transaminase activity, and bilirubin level were studied in 89 children with acute leukaemias and malignant lymphomas. The age of the children was from 7 months to 16 years. Fifteen children were examined before starting the treatment with cytostatics, 48 during intensive chemotherapy, and 26 during maintenance treatment. HBV markers were found in 53 children during intensive therapy and maintenance treatment. Out of 36 children with negative HBV infection markers 31 were examined before starting the treatment with cytostatics or during the first 6 months of treatment. Nine out of 53 children in whom HBV infection markers were found had aminotransferase activity raised over 100 u/l and/or bilirubin level over 5 mg/dl and in nine cases transaminase activity and bilirubin level were raised only slightly (below 100 u/l and below 5 wg/dl). In 53 children the results were normal. The high incidence of HBV infection in children with acute leukaemias and lymphomas indicates the necessity of routine prophylactic treatment in this group of patients.

From among 1464 children with ALL 167 (11.4%) at diagnosis had two or less than two years, 53 of them were infants. Most of them had a great tumor bulk, 15 had initial CNS infiltration and 31 WBCc greater than or equal to 100000/ML. 66 were treated according to St. Jude or LSA2L2 programs (the I group), 101 according to BFM programs (the II group). Complete remission was obtained in 85% of patients. In 63 children relapses occurred in the course of treatment whereas in 5 after the therapy cessation. In majority of cases, there were isolated relapses, mostly, they involved bone marrow. CNS involvement was found, in both mixed and isolated relapses, in 28 children (20%). 64 children are alive, in 43 of them the therapy was stopped. Kapla-Meier estimates for event free survival (EFS) after 8 years were 19 +/- 4.7% in the first group vs 37.38 +/- 6.3% in the second group. Due to therapy intensification the treatment results have been improved (p = 0.05) but still they are not satisfactory, particularly in case of infants and children with WBC greater than or equal to 100000/ML. Analysis of the lot of children showed that apart from age at ALL diagnosis and the initial WBC the methods of treatment are also the prognostic factors.

Forty-four children with autoimmune haemolytic anaemia (AIHA) are described: 31 had acute, subacute or chronic disease with warm autoantibodies and 13 had acute or chronic anaemia with cold autoantibodies. The commonest forms were the acute and subacute types with warm autoantibodies and these were more frequent in young children, while chronic AIHA occurred mainly among children at puberty. In about 16% the anaemia was accompanied by a chronic disorder but in over 50% the anaemia was preceded by an acute infection or immunization. The former gave rise mainly to chronic anaemia, but the latter was associated with the acute and subacute forms. In general the prognosis was good and death was never caused by anaemia per se. The prognosis was worse in patientw with clinical features of thrombocytopenia and bleeding and with the immunological findings of free autoantibodies in the serum and a positive direct antiglobulin test. In acute and subacute forms, treatment with corticosteroids and sometimes with blood transfusions was effective. In chronic forms of the disease it was often necessary to give additional immunosuppressive drugs or/and to perform a splenectomy.

The subject of analysis is a group of 111 children with acute lymphoid leukemia (ALL) whose remission has lasted at least 4 years since stopping treatment. Patients were observed from 4 to 18 years after ALL therapy. No symptoms of disease were observed in 110 children; one child had leukemic infiltration of the testes during the fifth year after stopping treatment. In this group of children no changes in physical development have been recorded, but a growth deficiency is sometimes noted. No symptoms of intrinsic organ lesions have been ascertained in most of the patients. All of the patients, except one with schizophrenia, lead normal lives and either attend school or go to work. Seven patients have healthy children, who were born 6-24 years after the beginning of the disease and 3-16 years after cessation of therapy.

Five patients, cured from acute lymphoblastic leukaemia (ALL), four women and one man, have seven healthy children: four girls and three boys. The children were born in the period from 13 to 25 years since the beginning of the disease and 5 to 16 years after cessation of monotherapy. Age of the children varied from 2 to 13 years. In two patients and in their children an inversion or a partial inversion of the heterochromatic region of chromosome 9 was observed.

Short-lived suppressor cell (SLSC) activity controlling T-lymphocyte colony formation in vitro was evaluated in patients with acute lymphoblastic leukemia (ALL). No SLSC activity was found in patients in acute phase of the disease. On the other hand, patients in remission frequently had higher SLSC activity than controls. No correlation between colony count and thymidine incorporation as well as T-cell numbers was found in ALL patients.

The distribution of the fluorescent euchrysine-binding grains in the peripheral and bonmarrow stem cells was estimated in 28 cases of different types of acute leukemia verified according to Lòffler's cytochemical classification. The relationship between the pattern of fluorescent euchrysine-binding grains of human stem cells and the cytochemical type of acute leukemias has been established. Consequently, the authors suggest that the euchrysine-binding grains pattern of human stem cells may have a diagnostic value in distinguishing between various types of acute leukemia.

Treatment results of 1304 children with ALL obtained in Poland are presented. A group of 524 patients has been subject to a detailed analysis. These patients have been treated in the years 1981-1985 according to the BFM Protocol. In this group the 6-years CCR probability amounts to 0.56.

2.5% solution in the form of oral drops (Gist-brocades) has been used in the treatment of Candida albicans infections of the mucous membranes in children with chronic blood diseases. Out of 34 children 28 recovered completely which is 82.3% of all cases. The highest effectiveness of the preparation was found in the group of children with acute infections. In all cases of chronic candidiasis the improvement of the clinical condition was obtained. Only few children have not shown the growth of Candida albicans in the control investigations.