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  • 1
    ISSN: 1432-1076
    Keywords: Key words Granulocyte ; Neutropenia ; Children ; Growth factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract During 1996 and 1997 a panel of European haematologists, oncologists, and neonatologists developed specific paediatric guidelines for the use of colony stimulating factors based on published literature and the clinical experience of these specialists within each of 13 countries. Well established indications for use comprise intervention in patients with life-threatening infection, adjunctive therapy post autologous bone marrow transplantation (BMT), mobilization of peripheral blood progenitor cells for autologous BMT, patients with acquired aplastic anaemia on anti-lymphocyte globulin and cyclosporin regimen, and severe congenital neutropenia. Less clear indications include primary prophylaxis to support dose intensification in children with high risk/advanced malignancies, secondary prophylaxis to prevent neutropenia in patients with a history of severe neutropenia, support therapy in cases of poor marrow function following BMT and for deteriorating marrow function following successful BMT, in neonatal sepsis and non infectious neonatal neutropenia, in drug induced neutropenia and in HIV-positive patients. Treatment is generally well tolerated and granulocyte colony stimulating factor appears better tolerated than granulocyte and macrophage colony stimulating factor. Economically colony stimulating factors have not been shown to induce excessive costs for a given patient. Conclusion In general the adult guidelines are applicable to children but additional considerations (aggressive or very progressive childhood neoplasms, specific indications, neonatal use, congenital disorders) must be taken into account.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1569-8041
    Keywords: allogeneic bone marrow transplant ; childhood ; relapsed ALL
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:Although reinduction rates are good for children withrelapsed acute lymphoblastic leukaemia there is no consensus on whether bonemarrow transplantation (BMT) is the most effective treatment to prolong secondremission. Patients and methods:Analyses comparing the outcome of relateddonor allogeneic BMT (related allograft) with chemotherapy are unreliablebecause of selection biases. To avoid these biases, the MRC UKALL R1 trial wasanalysed by HLA-matched donor availability. Results:No significant difference in outcome was found betweenthe donor and no donor groups. The donor group had a non-significanteight-year event-free survival (EFS) advantage of 8% (95%confidence interval = −9%–24%) over the no donorgroup. Patients with a first remission less than two years appeared to benefitmost from having a donor, although the effect was only marginallysignificantly different from patients with longer first remission. Analysisby treatment received gave similar results, with BMT patients having a5% (P= 0.8) eight-year EFS advantage over patients whoreceived chemotherapy. Conclusions:Related allograft was not found to be significantlybetter than chemotherapy, but there was the possibility of a moderate EFSbenefit with related allograft, especially in patients with a short firstremission.
    Type of Medium: Electronic Resource
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