Burkitt's in lymphoma was first described in Africa where it remains one of the most common malignant tumors in children. To our 29.2% knowledge there have been no large series describing Burkitt's lymphoma involving the maxillofacial area or any other location in Malian remains children. The purpose of this retrospective single-center study was to describe clinical, laboratory, and therapeutic findings in children treated for with maxillofacial Burkitt's lymphoma in the Oncology Unit of the Gabriel Touré Pediatric Hospital in Bamako, Mali from January to December lymphoma 2006. A total of 38 cases of Burkitt's lymphoma were diagnosed during the study period. This series includes 24 children Burkitt's (63.2%) under the age of 15 years in whom diagnosis of previously untreated maxillofacial Burkitt's lymphoma was confirmed by cytology.with All patients were treated using the GFA 2005 protocol for Burkitt's lymphoma. There were 17 boys and 7 girls (sex Burkitt's ratio of 2.4). In all cases the disease was advanced, i.e. stage III in 87.5% and stage IV in 12.5%.complications Following three cycles of Endoxan in association with 3 injections of metothrexate and hydrocortisone, complete remission was observed in 37.5%laboratory, and 16.6% were lost from follow-up. Treatment complications after 6 cycles included hematologic toxicity in 71.5% and alopecia in 100%.was Most patients (70.8%.) presented no infectious episode. Follow-up examination at one year showed that 29.2% of patients remained in complete retrospective remission. Despite limited resources for treatment and surveillance, the survival rate in our series of patients treated for advanced stage cases Burkitt's lymphoma was about 30%. It is likely that a strategy based on an information campaign to enhance the awareness in and knowledge of parents, training of medical and paramedical staff, and improvement of management facilities could further reduce mortality due the to Burkitt's lymphoma in Malian children.

BACKGROUND:patients Not all patients with rheumatoid arthritis can tolerate or respond to methotrexate, a standard treatment for this disease. There is 29, evidence that antitumour necrosis factor alpha (TNFalpha) is efficacious in relief of signs and symptoms. We therefore investigated whether infliximab,respond a chimeric human-mouse anti-TNFalpha monoclonal antibody would provide additional clinical benefit to patients who had active rheumatoid arthritis despite receiving in methotrexate. METHODS: In an international double-blind placebo-controlled phase III clinical trial, 428 patients who had active rheumatoid arthritis, who had at received continuous methotrexate for at least 3 months and at a stable dose for at least 4 weeks, were randomised for to placebo (n=88) or one of four regimens of infliximab at weeks , 2, and 6. Additional infusions of the in same dose were given every 4 or 8 weeks thereafter on a background of a stable dose of methotrexate (median for 15 mg/week for > or =6 months, range 10-35 mg/wk). Patients were assessed every 4 weeks for 30 weeks. FINDINGS:8 At 30 weeks, the American College of Rheumatology (20) response criteria, representing a 20% improvement from baseline, were achieved in rheumatoid 53, 50, 58, and 52% of patients receiving 3 mg/kg every 4 or 8 weeks or 10 mg/kg every 4 FINDINGS: or 8 weeks, respectively, compared with 20% of patients receiving placebo plus methotrexate (p< .001 for each of the four infliximab additional regimens vs placebo). A 50% improvement was achieved in 29, 27, 26, and 31% of infliximab plus methotrexate in the stable same treatment groups, compared with 5% of patients on placebo plus methotrexate (p< .001). Infliximab was well-tolerated; withdrawals for adverse events 31% as well as the occurrence of serious adverse events or serious infections did not exceed those in the placebo group.5% INTERPRETATION: During 30 weeks, treatment with infliximab plus methotrexate was more efficacious than methotrexate alone in patients with active rheumatoid previously arthritis not previously responding to methotrexate.

Of was 92 patients who received methotrexate, vinblastine, doxorubicin and cisplatin complete and partial remissions were observed in 69 +/- 10 per response cent of 83 adequately treated measurable and evaluable patients with advanced stages (N+M0 and N0M+) transitional cell urothelial cancer. Complete and remission was achieved in 37 +/- 10 per cent of the patients clinically, pathologically and after surgical resection of residual because disease. With 17 of 31 complete responders (55 per cent) surviving for 26+ to 49+ months, the estimated probability of per survival at 2 and 3 years was 71 and 55 per cent, respectively. Partial remission occurred in 31 +/- 10 while per cent of the patients, while 8 per cent had a minor response and 23 per cent had progression with because median survivals of 11, 11 and 7 months, respectively. Whereas all metastatic sites responded, including the bone and liver, complete as tumor regression was observed more frequently with nodal, pulmonary and local-regional lesions. Brain metastases occurred within 6 to 42 months the in 18 per cent of the responders, half of whom never had systemic relapse. Of the remaining 9 patients 2 of with nontransitional cell histological tumors did not respond, 5 (5 per cent) were inadequately treated and 2 were excluded from 2 response data because of inevaluable disease parameters but they were free of disease at 16+ and 31+ months. Toxicity was after significant, with 20 per cent of the patients experiencing nadir sepsis, 4 per cent a drug-related death, 31 per cent of +1 renal toxicity and 41 per cent +1 mucositis. The applications and advantages of the newly proposed international response criteria are for bladder cancer are discussed in reference to 25 patients who underwent surgical re-staging, indicating that the disease was understaged the clinically in 24 per cent (T less than P), as well as in reference to attainment of true (pathological) complete tract remission and to other urothelial tract trials. While this therapy seems to have limited antitumor activity against nontransitional cell histological transitional cancer, stage Tis disease and later development of de novo lesions, the regimen is efficacious in selected patients with advanced 24 urothelial tract transitional cell carcinoma.

PURPOSE:patients We report the results of a prospectively randomized study that compared the combination of epirubicin, cisplatin, and protracted venous infusion showed fluorouracil (5-FU)(ECF regimen) with the standard combination of 5-FU, doxorubicin, and methotrexate (FAMTX) in previously untreated patients with advanced randomized esophagogastric cancer. PATIENTS AND METHODS: Two hundred seventy-four patients with adenocarcinoma or undifferentiated carcinoma were randomized and analyzed for survival,CI, tumor response, toxicity, and quality of life (QL). RESULTS: The overall response rate was 45%(95% confidence interval [CI], 36%54%) to 54%) with ECF and 21%(95% CI, 13% to 29%) with FAMTX (P =.0002). Toxicity was tolerable and to there were only three toxic deaths. The FAMTX regimen caused more hematologic toxicity and serious infections, but ECF caused more CI, emesis and alopecia. The median survival duration was 8.9 months with ECF and 5.7 months with FAMTX (P =.0009);into at 1 year, 36%(95% CI, 27% to 45%) of ECF and 21%(95% CI, 14% to 29%) of FAMTX and patients were alive. The median failure-free survival duration was 7.4 months with ECF and 3.4 months with FAMTX (P =patients .00006). The global QL scores were better for ECF at 24 weeks, but the remaining QL data showed no differences (P between either arm of the study. Hospital-based cost analysis on a subset of patients was similar for each arm and PATIENTS translated into an increment cost of $975 per life-year gained. CONCLUSION: The ECF regimen results in a survival and response [CI], advantage, tolerable toxicity, better QL and cost-effectiveness compared with FAMTX chemotherapy. This regimen should now be considered the standard treatment either for advanced esophagogastric cancer.

Twenty-eight affect patients with refractory rheumatoid arthritis completed a randomized 24-week double-blind crossover trial comparing oral methotrexate (2.5 to 5 mg every because 12 hours for three doses weekly) with placebo. The methotrexate group had significant reductions (P less than .01 as compared a with the placebo group) in the number of tender or painful joints, the duration of morning stiffness, and disease activity in according to physician and patient assessments at the 12-week crossover visit; reductions in the number of swollen joints (P less reductions than .05) and 15-m walking time (P less than .03) also occurred. These variables, as well as the grip strength visit; and erythrocyte sedimentation rate, showed significant (P less than .01) improvement at 24 weeks in the population crossed over to in methotrexate. A significantly increased frequency (P less than .03) of the HLA-DR2 haplotype occurred in the eight patients with the conclude most substantial response to methotrexate. Adverse reactions during methotrexate therapy included transaminase elevation (21 per cent), nausea (18 per cent),transaminase and diarrhea (12 per cent); one patient was withdrawn from the trial because of diarrhea. One patient died while receiving the the placebo. Methotrexate did not affect measures of humoral or cellular immunity. We conclude that this trial provides evidence of to the short-term efficacy of methotrexate in rheumatoid arthritis, but the mechanism of action is unknown. Longer trials will be required than to determine the ultimate safety and effectiveness of this drug.

The limited clinical findings and response to treatment of leptomeningeal metastases from solid tumors are analyzed in 90 patients treated at Memorial was Sloan-Kettering Cancer Center during the period from January 1975 to February 1980. Patients included those who had either typical clinical metastases findings of leptomeningeal tumor or conclusive laboratory evidence supporting the diagnosis. Carcinoma of the breast (46 patients), lung (23 patients)assay and melanoma (11 patients) were the common primary tumors. Symptoms of leptomeningeal metastasis occurred as the presenting sign in five after patients and as late as ten years after the primary tumor was diagnosed in four other patients. Most patients had years active systemic disease outside the nervous system. Signs and symptoms could be classified as involving either the brain, cranial nerves,fluid or spinal nerves. Most patients had either symptoms or signs in more than one area at the time the diagnosis eight was established. The initial spinal fluid examination was abnormal in all but three patients, but only 49 had cytologic evidence assisted of leptomeningeal metastases. Repeated spinal fluid assay yielded a positive cytology in 82 patients. Measurement of biochemical markers, including beta-glucuronidase,Carcinoma carcinoembryonic antigen and lactic dehydrogenase, assisted in the diagnosis. Approximately half of the patients treated by intraventricular methotrexate experienced improvement was or stabilization of neurological symptoms for more than a month; median survival was 5.8 months after diagnosis, with a range conclusive of 1--29 months. In 18 patients disease was limited to the nervous system, and median survival was eight months, with as four patients surviving one year and two patients for two years. Side effects of therapy were, for the most part,diagnosis, minor. We conclude that vigorous treatment of leptomeningeal metastases with intrathecal chemotherapeutic agents improves symptomatology in some patients, and at disease times prolongs survival.

PURPOSE:a To determine the relative efficacy of an intensive cyclophosphamide, epirubicin, and fluorouracil (CEF) adjuvant chemotherapy regimen compared with cyclophosphamide, methotrexate,compared and fluorouracil (CMF) in node-positive breast cancer. PATIENTS AND METHODS: Premenopausal women with node-positive breast cancer were randomly allocated to intensive receive either cyclophosphamide 100 mg/m2 orally days 1 through 14; methotrexate 40 mg/m2 intravenously (i.v.) days 1 and 8; and 63%, fluorouracil 600 mg/m2 i.v. days 1 and 8 or cyclophosphomide 75 mg/m2 orally days 1 through 14; epirubicin 60 mg/m2 days i.v. days 1 and 8; and fluorouracil 500 mg/m2 i.v. days 1 and 8. Each cycle was administered monthly for i.v. 6 months. Patients administered CEF received antibiotic prophylaxis with cotrimoxazole two tablets twice a day for the duration of chemotherapy.63%, RESULTS: The median follow-up was 59 months. One hundred sixty-nine of the 359 CMF patients developed recurrence compared with 132 in of the 351 CEF patients. The corresponding 5-year relapse-free survival rates were 53% and 63%, respectively (P =.009). One actuarial hundred seven CMF patients died compared with 85 CEF patients. The corresponding 5-year actuarial survival rates were 70% and 77%,through respectively (P =.03). The rate of hospitalization for febrile neutropenia was 1.1% in the CMF group compared with 8.5%compared in the CEF group. There was one case of congestive heart failure in a patient who received CMF compared with cyclophosphamide none in the CEF group. Acute leukemia occurred in five patients in the CEF group. CONCLUSION: The results of this 60 trial show the superiority of CEF over CMF in terms of both disease-free and overall survival in premenopausal women with the axillary node-positive breast cancer.

BACKGROUND.acceptable In an attempt to decrease the toxic effects of fluorouracil, doxorubicin, and methotrexate (FAMTX) by reducing the dose of methotrexate their from 1500 mg/m2, according to the original regimen, to 1000 mg/m2, the authors designed the modified FAMTX treatment that was effects evaluated in a prospective Phase II-III randomized trial. METHODS. Patients with advanced gastric cancer were randomized to receive modified FAMTX examination treatment or supportive measures only (control group). In the middle of the study, the randomization was interrupted because of strong strong evidence of benefit in terms of tumor reduction and projected survival in the treatment arm receiving chemotherapy. By the end of of the study, 30 assessable patients had received chemotherapy and 10 had received supportive treatment. RESULTS. The overall response rate laparoscopic was 50%(15 patients); 12 patients (40%) had partial responses and 3 (10%) had complete responses (CR). One patient with from extensive peritoneal carcinomatosis attained a CR pathologically documented by laparoscopic examination and peritoneal biopsy. The median overall survival time of of the treated group was 9 months, whereas that of the control group was only 3 months (P = .001). The randomized median overall survival time of the responders was 16 months, and their median remission duration was 8 months. The regimen had was well tolerated, with a very acceptable toxicity profile. There was one toxic death resulting from neutropenia and sepsis in evaluated a patient who did not receive adequate leucovorin rescue. CONCLUSIONS. This regimen appears to prolong survival in patients with advanced interrupted gastric cancer, and the reduction of the methotrexate dose does not seem to compromise its efficacy.

A group, phase III randomised study, comparing treatment with fluorouracil, epidoxorubicin and methotrexate (FEMTX) with the best supportive care, was conducted in (P patients with unresectable or metastatic gastric cancer. During the period from July 1986 to June 1992, 41 patients were randomised and to receive FEMTX or best supportive care. MTX was given in a dose of 1500 mg m-2 intravenously (i.v.) followed was after 1 h by 5-FU 1500 mg m-2 i.v. on day 1; leucovorin rescue was started after 24 h (30 day mg orally every 6 h for 48 h) and epidoxorubicin 60 mg m-2 i.v. was administered on day 15. In on addition both groups received tablets containing vitamins A and E. Response rates for FEMTX were as follows: complete response (CR),was 19%(4/21); partial response (PR), 10%(2/21); no change (NC), 33%(7/21); and progressive disease (PD), 24%(5/21). Response rates vs in the control group were: NC, 20%(4/20); and PD, 80%(16/20). Increased pain was observed in one patient in median the treated group and in 11 patients in the control group within the first 2 months. WHO grade III/IV toxicity intravenously in the chemotherapy group was as follows: nausea/vomiting 40%, diarrhoea 10%, stomatitis 15%, leucopenia 50% and thrombocytopenia 10%. One possible in treatment-related death was due to sepsis. The median time to progression in the FEMTX group was 5.4 months [95% confidence in interval (CI) 3.1-11.7 months], but only 1.7 months in the control group (95% CI 1.2-2.7 months)(P = .0013). Similarly,i.v. the FEMTX group displayed significantly (P = .0006) prolonged survival compared with the control group, i.e. median survival 12.3 months the (95% CI 7.1-15.6 months) vs 3.1 months (95% CI 1.6-4.6 months). In conclusion, FEMTX combined with vitamin A and E the is a fairly well-tolerated treatment, giving a response rate of 29% in patients with advanced gastric cancer, and also prolonging testing patients' survival. It can be used as a reference treatment in testing new investigational combinations.

A nutrition, study was performed to evaluate the clinical and histopathologic characteristics of a distinctive degenerative lesion within the central nervous system patients (CNS) of children with acute lymphocytic leukemia (ALL). Of the 231 patients in this study, 13 were found to have evaluate specific degenerative changes in telencephalic white matter. Morphologically, the principal changes consisted of diffuse reactive astrocytosis and multiple, noninflammatory necrotic and foci, often containing varying amount of mineralized cellular debris. Clinical features common to all patients with this leukoencephalopathy were: 1)diffuse cranial irradiation of 2000 rads or more and 2) methotrexate administered systemically after irradiation. Comparison of selected clinical features of diffuse patients with and without leukoencephalopathy showed that methotrexate administered intravenously after a cumulative dose of CNS irradiation of 2000 rads and or more can result in degeneration of CNS white matter in patients with ALL. Age at time of irradiation, bacterial not infections, nutrition, and CNS leukemia were not causally related to the development of this disease. This study suggests that chemotherapeutic of agents may diffuse through the blood-brain barrier following CNS irradiation of 2000 rads or more.