Immunotherapy with oral BCG and serial immune evaluation in childhood lymphoblastic leukemia following three years of chemotherapy

Improved therapy for children with acute lymphoblastic leukemia

We have examined the factors influencing clinical prognosis in Japanese children with B-precursor acute lymphoblastic leukemia (ALL), who have been treated in consecutive chemotherapeutic trials from 1976 to 1995. During this time the results of treatment have steadily improved in children with average presenting features (age 1-10 years old and leukocyte counts > 50,000/microL). The 4-year event-free survival (EFS) estimates now exceed 85% in our current trials. Furthermore, high-dose methotrexate and intrathecal therapy could be substituted for cranial irradiation without an increase of central nervous system relapse rate. However, children with unfavorable presenting features (leukocyte counts > or = 50,000/microL; high-risk group) have a worse prognosis, although there is some improvement of outcome. The patients in the high-risk group have obtained the 4-year EFS rate of better than 60%. Further investigations of prognostic factors in ALL focused on the biological features may permit identification of groups of children at risk of very poor outcome. In the patient cohorts consistently resistant to chemotherapy, the hazards of more intensive treatment such as bone marrow transplantation may be outweighed by the possible benefits.

Incidence of cancer in 98 patients with common varied immunodeficiency

Ninety-eight patients with common varied immunodeficiency have been observed for periods of 1-13 years. In 1986, 78 were alive, 19 had died, and 1 could not be located. Eleven patients in the group had developed cancer; two patients had had two cancers. Of the total number of neoplastic malignancies, seven were non-Hodgkin's lymphoma, one patient had a Waldenstrom's macroglobulinemia, and nine of the patients who developed cancer were female. Cancer developed in the fifth or sixth decade of life for 10 of the 11 patients. These data show an 8- to 13-fold increase in cancer in general for patients who have this immunodeficiency and a 438-fold increase in lymphoma for females.