Prevention of infection in children with acute leukaemia - No major difference between total and selective bowel decontamination

To evaluate the effect of total bowel decontamination (TD) and selective bowel decontamination (SD) in a non-protective environment clinical and laboratory data of children treated for acute leukaemia between 1983 and 1991 were analysed retrospectively. From 1983 until 1989 34 patients [18 acute non-lymphoblastic leukaemia (ANLL) patients, 16 acute lymphoblastic leukaemia (ALL) patients] received TD and 31 patients (8 ANLL patients, 23 ALL patients) received SD from 1987 until 1991. TD consisted of colistin sulphate, neomycin, cephaloridine and amphotericin B orally as well as Orabase and sterilized food, while the patients were nursed in a single room. SD consisted of oral colistin sulphate, neomycin and amphotericin B. Those patients with ANLL were nursed in a single roomy patients with ALL were nursed in a single room during remission induction therapy only. All patients except those with ANLL receiving TD received Pneumocystis carinii pneumonia prophylaxis with cotrimoxazole. Because the two groups were heterogeneous for diagnosis and chemotherapy the occurrence of fever (central body temperature at least 38.5 degrees C) and major infections (septicaemia or infections of the deep tissues or organs) were registered during periods of neutropenia (neutrophilic granulocytes less than or equal to 500/mm(3) for at least 8 days). Patients on TD had 55 periods of neutropenia, patients on SD 80, Patients on TD had 89.1 periods of fever/100 periods of neutropenia whereas patients on SD had 56.3. Also patients on TD had 27.3 major infections/100 periods of neutropenia whereas patients on SD had 11.3, Major infections predominantly consisted of septicaemia caused by gram-positive bacteria. We conclude that, in this study, TD in a non-protective environment does not offer better protection against major infections than SD in patients with ALL or ANLL

IMMUNOLOGICAL RESPONSES IN AN INFANT AFTER CYCLOSPORINE-A EXPOSURE DURING PREGNANCY

Pregnancy in transplant recipients is not uncommon. Cyclosporin A may be used as an immunosuppressive drug in these patients. Almost no data exist on the effects of cyclosporin A on the immune system of infants who have been exposed to this drug in utero. The infant of a liver transplant recipient was followed during the first 2 years of life. Shortly after birth all lymphocyte subsets were low, especially for B-cells. The distribution of lymphocytes returned to low normal ranges within the first 2 years of life, except for CD8 values that stayed below normal. There were no signs of persistent adverse effects of cyclosporin A on the functional integrity of the immune system

HETEROGENEITY AMONG THE ACUTE NONLYMPHOCYTIC LEUKEMIAS - VALUE OF IMMUNOPHENOTYPE FOR DIAGNOSIS, PROGNOSIS, AND THERAPY

Immunophenotyping of acute nonlymphocytic leukemia has confirmed previous observations on the heterogeneity of this disease. The lack of leukemia-specific monoclonal antibodies as well as antibodies reactive with early myeloid cells is reflected in poor correlation of morphologically and cytochemically defined FAB classes with the immunophenotype of the leukemic cells. Possible exceptions are the microgranular variant of FAB-M3, megakaryocytic leukemia (FAB-M7), and early erythroid leukemias (FAB-M6). The use of antibody panels can alleviate the differential diagnosis of acute lymphoid and myeloid leukemias, especially those occurring in infants, and the discrimination of FAB-L2 and FAB-MI. Also, the immunophenotyping of presumptive hybrid leukemias can help to resolve the many questions about these leukemias with a particularly poor prognosis. The challenge for multiinstitutional groups is to define those clinically relevant subgroups of acute nonlymphocytic leukemia in children that have general acceptance and could provide the basis for new treatment strategies