Analysis of treatment in childhood leukemia. IV. The critical association between dose fractionation and immunosuppression induced by cranial irradiation
✍ Scribed by I. C. M. Maclennan; H. E. M. Kay
- Publisher
- John Wiley and Sons
- Year
- 1978
- Tongue
- English
- Weight
- 361 KB
- Volume
- 41
- Category
- Article
- ISSN
- 0008-543X
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✦ Synopsis
The degree of long term lymphopenia induced by cranial irradiation is shown to be dependent upon the number of fractions into which the standard cranial dose of 2400 rads is divided. The mean lymphocyte count of patients three months after receiving this dose in five fractions was 1.84 X 108/1; in twelve fractions it was 1.12 X 109/1 and in twenty fractions it was 0.64 X 109/l. An explanation for this finding is offered which is based upon marked radiosensitivity of certain lymphocytes and the pattern of recirculation and redistribution of these cells.
Cancer 41:108-111, 1978. ENINGEAL RELAPSE IS A COMMON COMPLI-M cation in patients with acute lymphoblastic leukaemia who are only given systemic ~hemotherapy.~*'," However, the St. Jude Hospital Group has shown that this complication can be largely prevented if appropriate prophylactic treatment is given to the central nervous system (CNS) shortly after patients have achieved remission. They demonstrated the effectiveness of both 2400 rads cranial irradiation with five doses of intrathecal methotrexate' and 2400 rads craniospinal irradiation in preventing CNS relapse. Unfortunately this treatment is both immunosuppressive**'0 and myelosuppressive,' and may be associated with a From the