Oral methotrexate is as effective as intramuscular in maintenance therapy of acute lymphoblastic leukaemia.

Chessells, J M; Leiper, AD; Tiedemann, K.; Hardisty, R. M.; Richards, Susan

doi:10.1136/adc.62.2.172

Cited by 32 publications

(12 citation statements)

References 8 publications

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“…Between 1970 and 1979, chemotherapy regimens consisted of protocols devised by the Medical Research Council Working Party on Childhood Leukaemia (UKALL trials) [5]. From 1980 to 1986, protocols were those devised by or piloted at HSC [6] and UKALL X [7], Central nervous system prophylaxis was introduced in 1972 and consisted of 2,400 cGy in 15 fractions over 19 days accompanied by intrathecal methotrexate. Initially, a few children received craniospinal irradiation.…”

Section: Methodsmentioning

confidence: 99%

Precocious or Early Puberty and Growth Failure in Girls Treated for Acute Lymphoblastic Leukaemia

Leiper¹,

Stanhope

Preece

et al. 1988

Horm Res

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We have studied 41 children with early or precocious puberty who have been treated for acute lymphoblastic leukaemia with prophylactic cranial irradiation (1,800–2,400 cGy) accompanied by intrathecal methotrexate and systemic chemotherapy. Mean age at radiotherapy was 3.9 years (range 1.7–7.7) in the girls and 4.8 years (range 2.6–7.8) in the boys. Mean age at the onset of puberty was 8.6 years (range 6.7–9.7) in the girls and 9.3 years (range 7.8–10.3) in the boys. Of the 41 children with early puberty (greater than 1.4 SD from the mean) 36 were females and 5 were males. 21 of the 36 girls had an absent or inadequate growth acceleration of puberty. 7 of 12 girls who had a pharmacological test of growth hormone (GH) secretion had GH insufficiency (peak level less than 20 mU/l). Early or precocious puberty combined with GH insufficiency may produce severe growth failure and we have used a treatment regimen of a gonadotrophin-releasing hormone analogue, in order to reduce the rate of epiphyseal maturation, combined with biosynthetic GH to increase or sustain growth rate. We have treated 4 girls in this manner. During a mean treatment period of 0.86 years, height SDS for bone age rose from a mean of-1.06 to -0.59. Longer treatment periods will be required to assess the effect on final height.

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Section: Methodsmentioning

confidence: 99%

Precocious or Early Puberty and Growth Failure in Girls Treated for Acute Lymphoblastic Leukaemia

Leiper¹,

Stanhope

Preece

et al. 1988

Horm Res

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“…Subsequently, St. Jude Children's Research Hospital's Total X Study has demonstrated that infusions of methotrexate 1,000 mg/m2 given three times during consolidation and every 6 weeks in maintenance conferred a higher event-free survival than standard consolidation with cranial irradiation and maintenance with oral 6-mercaptopurine and methotrexate plus pulses of doxorubicin, cyclophosphamide, teniposide, and cytarabine [24]. Neither Chessels et al nor the Medical Research Council Working Party (MRC) were able to demonstrate any benefit to weekly intramuscular methotrexate given at the standard 20 mg/m2 dose, but the MRC did find that the parenteral route was more neurotoxic among patients who had also received prophylactic cranial irradiation [25].…”

Section: Discussionmentioning

confidence: 98%

Randomized comparison of moderate-dose methotrexate infusions to oral methotrexate in children with intermediate risk acute lymphoblastic leukemia: A Childrens Cancer Group study

Lange

Blatt

Sather

et al. 1996

Med. Pediatr. Oncol.

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“…Patients with ALL had been previously treated using protocols established by the Medical Research Council [5], the United Kingdom Children's Cancer Study Group [12] or by the Hospital for Sick Children [4], Intrathecal methotrexate and/or cytosine was used in all patients to prevent leukaemic meningeal infiltration. Patients with acute myeloid lenkaemia were treated with either daunorubicin, cytosine arabinoside and thioguanine alone (Medical Research Council, acute myeloid leukaemia VIII) or with two courses of this prior to one course of M-AMSA, azacytidine and etoposide VP16.…”

Section: Patientsmentioning

confidence: 99%

Growth following single fraction and fractionated total body irradiation for bone marrow transplantation

Thomas¹,

Stanhope²,

Plowman

et al. 1993

Eur J Pediatr

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Total body irradiation (TBI) is used as preparative regimen prior to bone marrow transplantation (BMT). Since there are more long-term survivors, follow up studies are important. We have performed a retrospective analysis of growth for 49 children, who had undergone treatment with cyclophosphamide and TBI before BMT. Of these patients 26 received single fraction (SF) TBI as a dose of 900-1000 cGy, whereas 23 received fractionated (FF) TBI as a total dose of either 1200 cGy divided in six fractions or 1440 cGy divided in eight fractions over 3 days. Half of the patients in the SF-TBI group, and 9 in the FF-TBI group had received low-dose cranial irradiation prior to TBI. In all groups a decrease in height SDS was observed. By evaluating the major factors leading to growth impairment the influence of cranial irradiation, which was demonstrable in the 1st year after TBI, could not be shown after 3 years. At this time growth was significantly more impaired in the SF group with a mean height SDS of -0.9 (+/- SD 0.9) compared to a mean height SDS -0.22 (1.02) in the FF group (P < 0.05). Measurement of segmental proportions showed a significant difference in SDS for sitting height in comparison to SDS for subischial leg length, irrespective of the TBI regimen. This was already evident 1 year after TBI and decreased during the following years. Twenty four of the patients (17 in the single fraction and 7 in the fractionated TBI group) were treated with growth hormone, but demonstrated an inappropriate response with absent catch-up growth in their legs.(ABSTRACT TRUNCATED AT 250 WORDS)

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Oral methotrexate is as effective as intramuscular in maintenance therapy of acute lymphoblastic leukaemia.

Cited by 32 publications

References 8 publications

Precocious or Early Puberty and Growth Failure in Girls Treated for Acute Lymphoblastic Leukaemia

Precocious or Early Puberty and Growth Failure in Girls Treated for Acute Lymphoblastic Leukaemia

Randomized comparison of moderate-dose methotrexate infusions to oral methotrexate in children with intermediate risk acute lymphoblastic leukemia: A Childrens Cancer Group study

Growth following single fraction and fractionated total body irradiation for bone marrow transplantation

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