Acute lymphocytic leukemia chemotherapy

TABLE 92-7. Representative Chemotherapy Regimens for Adult Acute Lymphocytic Leukemia... 

Other Methotrexate also is indicated as an antineoplastic chemotherapy in various types of cancers and acute lymphocytic leukemia. 

The existence of the blood-brain barrier is an important consideration in the chemotherapy of neoplastic diseases of the brain or meninges. Poor drug penetration into the CNS has been a major cause of treatment failure in acute lymphocytic leukemia in children. Treatment programs for this disease now routinely employ craniospinal irradiation and intrathecally administered methotrexate as prophylactic measures for the prevention of relapses. The testes also are organs in which inadequate antitumor drug distribution can be a cause of relapse of an otherwise responsive tumor. 

Daunomycin and its analog adriamycin are in clinical use as potent antitumor agents in combination chemotherapy against acute lymphocytic leukemia. It has been suggested that the antitumor properties are associated with intercalation of the anthracycline ring of the antibiotic into the DNA of rapidly proliferating neoplastic cells and subsequent blocking of RNA synthesis (72-75). [5]... 

Acute lymphocytic leukemia in combination with chemotherapy... 

Pennybacker J, Russell DS Necrosis of the brain due to radiation therapy clinical and pathological observations. J Neurol Neurosurg Psychiatry 11 183-198, 1948 Peylan-Ramu N, Poplack DG, Pizzo PA, et al Abnormal CT scans of the brain in asymptomatic children with acute lymphocytic leukemia after prophylactic treatment of the central nervous system with radiation and intrathecal chemotherapy. N Engl J Med 298 815-818,1978... 

Glucocorticoids are used in the chemotherapy of acute lymphocytic leukemia and lymphomas because of their antilymphocytic effects (see Chapter 51). 

Two sub-types of acute lymphocytic leukemia are T and B lymphoblastic leukemia. The leukemic T and B cells are neoplastic versions of normal T and B immune cells. One treatment for this type of leukemia is autologous bone marrow transplant (autoBMT) where cells are collected Ifom the patient s blood or bone marrow. The patient then undergoes chemotherapy and/or radiation therapy to kill remaining cancer cells before collected cells are returned. The collected cells are treated to remove cancer cells but, because the methods are imperfect, some cancer cells are re-introduced into the patient. 

Bestatin (ubenimex) is a potent inhibitor of aminopeptidase N and aminopeptidase B,89 which was isolated from a culture filtrate of Streptomyces olivoreticuli during the search for specific inhibitors of enzymes present on the membrane of eukaryotic cells.90 Inhibitors of aminopeptidase activity are associated with macrophage activation and differentiation, Bestatin has shown significant therapeutic effects in several clinical trials.91 In a multi-institutional study,92 patients with acute non-lymphocytic leukemia (ANLL) were randomized to receive either Bestatin or placebo orally after completion of induction and consolidation therapy, and concomitant with maintenance chemotherapy. Remission duration was prolonged in the Bestatin group, although this difference did... 

A. Glucocorticoids Prednisone is the most commonly used glucocorticoid in cancer chemotherapy. The steroid has applications in dmg regimens for acute and chronic lymphocytic leukemia. Hodgkin s disease (MOPP regimen), and other lymphomas. Toxicity is described in Chapter 39. 

Examples (a) Cancerous tumors having high growth fractions which are foimd to give adequate response to chemotherapy are, namely Hodgkin s disease, Burkitt s lymphoma, Wilm s tumour, acute leukemia in children, choriocarcinoma, chronic myelogenous leukemia, lymphocytic leukemia, and breast cancer. 

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