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January 1980, Vol 134, No. 1 >
Article | January 1980

Pneumonia During Therapy for Childhood Acute Lymphoblastic Leukemia FREE

Stuart E. Siegel, MD; Mark E. Nesbit, MD; Robert Baehner, MD; Harland Sather, MD; G. Denman Hammond, MD
[+] Author Affiliations

Reprint requests to Childrens Cancer Study Group, Operations Office, 1721 Griffin Ave, Los Angeles, CA 90031.


Am J Dis Child. 1980;134(1):28-34. doi:10.1001/archpedi.1980.02130130020007.
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• The incidence of pneumonia was evaluated in 844 children undergoing initial treatment for acute lymphoblastic leukemia (ALL). A total of 310 episodes occurred in 239 patients followed up for five to 36 months after diagnosis. The peak incidences occurred in the periods 0 to 20 days and 40 to 80 days after the start of antileukemic therapy. Bacterial pneumonias occurred primarily during the first 20 days after diagnosis of ALL. No episode of Pneumocystis carinii pneumonia was noted before 40 days, and the majority of instances occurred 50 to 120 days after diagnosis. In 80% of all episodes, a specific causative organism was not detected. The incidence of P carinii pneumonia was greater in patients receiving intrathecal methotrexate as part of CNS prophylaxis than in those receiving only CNS irradiation. Pneumonia is a frequent event during the therapy of ALL in childhood.

(Am J Dis Child 134:28-34, 1980)

REFERENCES

1 +
Levine AS, Schimpff SC, Graw RG Jr, et al:  Hematologic malignancies and other marrow failure states: Progress in the management of complicating infections . Semin Hematol 11:141-205, 1974;.
2 +
Bodey GP, Powell RD Jr, Hersh EM:  Pulmonary complications of acute leukemia . Cancer 19:781-793, 1966;.
3 +
Hughes WT, Feldman S, Cox F:  Infectious diseases in children with cancer . Pediatr Clin North Am 21:583-615, 1974;.
4 +
Hughes WT, Smith DR:  Infection during induction of remission in acute lymphocytic leukemia . Cancer 31:1008-1014, 1973;.
5 +
Hersh EM, Bodey GP, Nies BA, et al:  Causes of death in acute leukemia . JAMA 193:105-109, 1965;.
6 +
Simone JV, Holland E, Johnson W:  Fatalities during remission of childhood leukemia . Blood 39:759-770, 1972;.
7 +
Iacuone JJ, Wong KY, Bove KE, et al:  Acute respiratory illness in children with acute lymphoblastic leukemia . J Pediatr 90:915-919, 1977;.
8 +
Rubin P, Casarett GW: Clinical Radiation Pathology . Philadelphia, WB Saunders Co, 1968;, vol 1, pp 423-470.
9 +
Wohl MEB, Griscom NT, Traggis DG:  Effects of therapeutic irradiation delivered in early childhood upon subsequent lung function . Pediatrics 55:507-516, 1975;.
10 +
Smith JC:  Radiation pneumonitis . Am Rev Respir Dis 87:647-655, 1963;.
11 +
Boushy SF, Helgason AH, North LB:  The effect of radiation on the lung and bronchial tree . Am J Roentgenol 108:284-292, 1960;.
12 +
Weir GJ, Michaelson SM: Pulmonary Radiation Reactions . Springfield, Ill, Charles C Thomas Publishers, 1971;.
13 +
Whitfield AGW, Bond WH, Kunkler PB:  Radiation damage to thoracic tissues . Thorax 18:371-380, 1963;.
14 +
Clarysse AM, Cathey WJ, Cartwright GE, et al:  Pulmonary disease complicating intermittent therapy with methotrexate . JAMA 209:1861-1864, 1969;.
15 +
Robbins KM, Gribetz E, Strauss L, et al:  Pneumonitis in acute lymphatic leukemia during methotrexate therapy . J Pediatr 82:84-88, 1963;.
16 +
Whitcomb ME, Schwartz MI, Tormey DC:  Methotrexate pneumonitis: Case report and review of the literature . Thorax 27:636-639, 1972;.
17 +
Everts CS, Westcott JL, Bragg DG:  Methotrexate therapy and pulmonary disease . Radiology 107:539-543, 1973;.
18 +
Bhat KSS, Anderson KR, Stewart RDH:  Lung disease associated with methotrexate therapy . Aust NZ J Med 4:277-280, 1974;.
19 +
Lisbona A, Schwartz J, Lachance C, et al:  Methotrexate-induced pulmonary disease . J Canad Assoc Radiol 24:215-220, 1973;.
20 +
Iyer R, Ravindramath Y, Kulkaini R, et al:  Bilateral interstitial pneumonia in acute lymphoblastic leukemia . Am J Hematol 1:225-235, 1976;.
21 +
Peto R, Pike MC, Armitage P, et al:  Design and analysis of randomized clinical trials requiring prolonged observation of each patient: II. Analysis and examples . Br J Cancer 35:1-39, 1977;.
22 +
Wilder CS:  Acute respiratory illnesses reported to the US National Health Survey during 1957-1962 . Am Rev Respir Dis 88:14-21, 1963;.
23 +
Glezen WP, Loda FA, Clyde WA, et al:  Epidemiologic patterns of acute lower respiratory disease of children in a pediatric group practice . J Pediatr 78:397-406, 1971;.
24 +
Wolff LJ, Bartlett MS, Baehner RL, et al:  The causes of interstitial pneumonitis in immunocompromised children: An aggressive systematic approach to diagnosis . Pediatrics 60:41-45, 1977;.
25 +
Bodey GP, Buckley M, Sathe YS, et al:  Quantitative relationship between circulating leukocytes and infection in patients with acute leukemia . Ann Intern Med 64:328-340, 1966;.
26 +
Ruebush TK, Weinstein RA, Baehner RL, et al:  An outbreak of pneumocystis pneumonia in children with acute lymphocytic leukemia . Am J Dis Child 132:143-148, 1978;.
27 +
Newhouse M, Sanchis J, Bieronstock J:  Lung defense mechanisms . N Engl J Med 295:1045-1052, 1976;.
28 +
Sieger L:  Pulmonary alveolar macrophages in pre- and post-natal rabbits . J Reticuloendothel Soc 23:389-395, 1978;.
29 +
Hughes WT, Kuhn RN, Chaudhary MD, et al:  Successful chemoprophylaxis for Pneumocystis carinii pneumonitis . N Engl J Med 297:1419-1426, 1977;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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References

1 +
Levine AS, Schimpff SC, Graw RG Jr, et al:  Hematologic malignancies and other marrow failure states: Progress in the management of complicating infections . Semin Hematol 11:141-205, 1974;.
2 +
Bodey GP, Powell RD Jr, Hersh EM:  Pulmonary complications of acute leukemia . Cancer 19:781-793, 1966;.
3 +
Hughes WT, Feldman S, Cox F:  Infectious diseases in children with cancer . Pediatr Clin North Am 21:583-615, 1974;.
4 +
Hughes WT, Smith DR:  Infection during induction of remission in acute lymphocytic leukemia . Cancer 31:1008-1014, 1973;.
5 +
Hersh EM, Bodey GP, Nies BA, et al:  Causes of death in acute leukemia . JAMA 193:105-109, 1965;.
6 +
Simone JV, Holland E, Johnson W:  Fatalities during remission of childhood leukemia . Blood 39:759-770, 1972;.
7 +
Iacuone JJ, Wong KY, Bove KE, et al:  Acute respiratory illness in children with acute lymphoblastic leukemia . J Pediatr 90:915-919, 1977;.
8 +
Rubin P, Casarett GW: Clinical Radiation Pathology . Philadelphia, WB Saunders Co, 1968;, vol 1, pp 423-470.
9 +
Wohl MEB, Griscom NT, Traggis DG:  Effects of therapeutic irradiation delivered in early childhood upon subsequent lung function . Pediatrics 55:507-516, 1975;.
10 +
Smith JC:  Radiation pneumonitis . Am Rev Respir Dis 87:647-655, 1963;.
11 +
Boushy SF, Helgason AH, North LB:  The effect of radiation on the lung and bronchial tree . Am J Roentgenol 108:284-292, 1960;.
12 +
Weir GJ, Michaelson SM: Pulmonary Radiation Reactions . Springfield, Ill, Charles C Thomas Publishers, 1971;.
13 +
Whitfield AGW, Bond WH, Kunkler PB:  Radiation damage to thoracic tissues . Thorax 18:371-380, 1963;.
14 +
Clarysse AM, Cathey WJ, Cartwright GE, et al:  Pulmonary disease complicating intermittent therapy with methotrexate . JAMA 209:1861-1864, 1969;.
15 +
Robbins KM, Gribetz E, Strauss L, et al:  Pneumonitis in acute lymphatic leukemia during methotrexate therapy . J Pediatr 82:84-88, 1963;.
16 +
Whitcomb ME, Schwartz MI, Tormey DC:  Methotrexate pneumonitis: Case report and review of the literature . Thorax 27:636-639, 1972;.
17 +
Everts CS, Westcott JL, Bragg DG:  Methotrexate therapy and pulmonary disease . Radiology 107:539-543, 1973;.
18 +
Bhat KSS, Anderson KR, Stewart RDH:  Lung disease associated with methotrexate therapy . Aust NZ J Med 4:277-280, 1974;.
19 +
Lisbona A, Schwartz J, Lachance C, et al:  Methotrexate-induced pulmonary disease . J Canad Assoc Radiol 24:215-220, 1973;.
20 +
Iyer R, Ravindramath Y, Kulkaini R, et al:  Bilateral interstitial pneumonia in acute lymphoblastic leukemia . Am J Hematol 1:225-235, 1976;.
21 +
Peto R, Pike MC, Armitage P, et al:  Design and analysis of randomized clinical trials requiring prolonged observation of each patient: II. Analysis and examples . Br J Cancer 35:1-39, 1977;.
22 +
Wilder CS:  Acute respiratory illnesses reported to the US National Health Survey during 1957-1962 . Am Rev Respir Dis 88:14-21, 1963;.
23 +
Glezen WP, Loda FA, Clyde WA, et al:  Epidemiologic patterns of acute lower respiratory disease of children in a pediatric group practice . J Pediatr 78:397-406, 1971;.
24 +
Wolff LJ, Bartlett MS, Baehner RL, et al:  The causes of interstitial pneumonitis in immunocompromised children: An aggressive systematic approach to diagnosis . Pediatrics 60:41-45, 1977;.
25 +
Bodey GP, Buckley M, Sathe YS, et al:  Quantitative relationship between circulating leukocytes and infection in patients with acute leukemia . Ann Intern Med 64:328-340, 1966;.
26 +
Ruebush TK, Weinstein RA, Baehner RL, et al:  An outbreak of pneumocystis pneumonia in children with acute lymphocytic leukemia . Am J Dis Child 132:143-148, 1978;.
27 +
Newhouse M, Sanchis J, Bieronstock J:  Lung defense mechanisms . N Engl J Med 295:1045-1052, 1976;.
28 +
Sieger L:  Pulmonary alveolar macrophages in pre- and post-natal rabbits . J Reticuloendothel Soc 23:389-395, 1978;.
29 +
Hughes WT, Kuhn RN, Chaudhary MD, et al:  Successful chemoprophylaxis for Pneumocystis carinii pneumonitis . N Engl J Med 297:1419-1426, 1977;.

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