Recent advances in management of acute leukemia

Resident: Roberts

Date: 1/29/10

Author: Chessells

Journal: Arch Dis Child

Year: 2000

Pages: 438-432

Discussion:

Leukemia is a clonal disease resulting from genetic mutations and transformation of a single early progenitor myeloid or lymphoid cell. Despite much research limited understanding of the exact cause is known.

ALL: Over 95 percent of children with ALL achieve remission after three to four weeks of treatment with oral steroids, , weekly IV vincristine and a third drug L-Asparaginase.. If chemotherapy is performed within the first 8 - 10 months from diagnosis, it significantly reduces relapse.

AML: These patients require intense hospital based chemotherapy which produces bone marrow suppression. A therapy that requires upto five courses of treatment and a bone marrow transplant has increased survival rates upwards of 48 percent at seven years.

Relapse: 30 percent with ALL and 45 percent with AML relapse. Those that relapse after the first few months of remission have a good chance at achieving a second remission. If they relapse after two years the chance of cure is almost impossible.

Conclusions: There have been significant improvement in the outlook for children with acute leukemia. There is still room for improvement with conventional chemotherapy and the need for randomized trials. New treatment is needed for relapsed patients due to poor prognosis.

An update of the etiology and management of xerostomia 1/29/10

Department of Pediatric Dentistry
Resident’s Name:Murphy
Program: Lutheran Medical Center – Providence
An update of the etiology and management of xerostomia
Author(s): Porter, SR, et al
Journal: Oral Surgery Oral Medicine Oral Pathology
Year. Volume (number). Page #’s: Jan 2004. 97:1. 28-41
Major topic: Etiology of xerostomia and is implications
Minor topic(s): Treatments of xerostomia
Overview of method of research: Review article

Findings:
Xerostomia(X), aka dry mouth is the abnormal reduction of saliva. It can be a symptom of certain diseases, or an adverse effect of medications. Causes of X are many, including Sjogrens Symdrome(SS), sarcoidosis, HIV, HCV infection, diabetes, radiation to head and neck, chemotherapy, chronic graft-versus-host disease, medications(to date X has been associated with more than 500 drugs, see link for list below), and trauma.
SS is the second most common autoimmune connective tissue disorder. It is a chronic multisystem immune mediated disorder characterized by inflammation of exocrine glands, which leads to dryness of the eyes and mouth. It can either be a primary or secondary disease. Treatment includes use of interferon alpha(a), corticosteroids, and hydroxychloroquine. SS is currently not very well understood, and has not responded well to immunosuppressive therapy. More research is needed.
Management of Xerostomia
Everything from dietary changes to medicines have been used to try to curtail the symptoms of X. Topical agents such as salivary substitutes, lubricating agents such as gels, mouthwashes, lozenges, pastilles(Salivix, Provalis), mucin sprays(yes) and chewing sugar free gum are all common, economical ways try to improve the symptoms of X. Systemic medicines are also used to treat X. Cholinergic agonists such as pilocarpine and cevimeline are extremely popular drugs used to treat X. Other drugs used are bethanechol, carbacholine, pyridostigmine, and bromhexine. As of right now, Bethanechol and cevmeline are the only drugs that are efficacious in the treatment of drug induced X.
Some alternative method of treating X include electro-stimulation, acupuncture, and dietary supplementation.
Pilocarpine

Key points/Summary: Currently anticholinergic agents hold the most promise and are most appropriate for the treatment of radiation induced X. Greater knowledge of salivary gland disorders must be studied before specific therapies can be developed. For drug induced X, try getting the MD to switch the patient to another drug.

Assessment of Article: Good article. Wasn’t as boring as I thought it would be. Informative. They didn’t really go over any new therapies, which I thought they would. It was just…(more research needed).

Drug List
http://www.drcarpenter.com/Media/PDFs-Documents/DrugsThatCauseXerostemia.pdf