Cyclophosphamide-asparaginase- vincristine-prednisone induction therapy in childhood acute lymphocytic and nonlymphocytic leukemia.

A remission-induction regimen for childhood leukemia using cyclophosphamide, asparaginase, vincristine, and prednisone (CAVP) was compared to standard vincristine-prednisone (VP) induction. The more intensive regimen was associated with a lower complete remission rate (81% vs 93%) and a higher early death rate from infection (15% vs 5%) for acute lymphocytic leukemia. In contrast, complete remission was achieved in 58% of children with acute nonlymphocytic leukemia treated with CAVP compared to 18% for VP. Early death rates were similar (27% vs 25%). These observations corroborate previous studies in childhood nonlymphocytic leukemia showing activity for asparaginase. Preliminary analysis of remission duration and survival for responders shows no advantage for those who survived the more intensive induction.     

Pulmonary Embolism and Intracardiac Shunt: A Unique Indication for Operation

Pulmonary embolism with right-to-left intracardiac shunt presents a special problem for the clinician. A review of the literature and 4 personal cases, all diagnosed antemortem, are presented. On the basis of this information certain conclusions are drawn, and we suggest the problem to be a unique indication for the consideration of surgical intervention.