Howard, M.D., Vickey Simmons, R.N., Amy Bayles, C.P.N.P., Monika L. Metzger, M.D., James M. Boyett, Ph.D., Wing Leung, M.D., Ph.D., Rupert Handgretinger, M.D., James R. Downing, M.D., William E. Evans, Pharm.D., and Mary V. Relling, Pharm.D.: Treating Childhood Acute Lymphoblastic Leukemia without Cranial Irradiation Clinical trials have yielded 5-year event-free survival prices as high as 79 to 82 percent among children with severe lymphoblastic leukemia .1-3 A significant challenge would be to reduce treatment-related late effects, which can occur in more than two thirds of long-term survivors.4 In an evergrowing proportion of individuals, prophylactic cranial irradiation, once a standard treatment, is being replaced by intrathecal and systemic chemotherapy to reduce radiation-associated late complications such as for example second cancers, cognitive deficits, and endocrinopathy.4-8 Two pediatric medical trials tested whether prophylactic cranial irradiation could be completely omitted from treatment.9,10 Even though cumulative risks of isolated central nervous system relapse in these trials were relatively low , event-free survival rates were only 68.4 percent and 60.7 percent, respectively.Exacerbations There were 4411 individual episodes of exacerbation among 2691 patients; 44 percent of the individuals with an exacerbation experienced moderate COPD at the trial onset . Enough time to the 1st exacerbation was increased by 42 days with tiotropium in comparison with salmeterol , corresponding to a 17 percent reduction in risk with tiotropium . Given the truth that less than 50 percent of the patients had an exacerbation , it was not possible to calculate the median time and energy to the first exacerbation; therefore, the time to the 1st exacerbation in the first quartile of sufferers was calculated instead. Tiotropium as compared with salmeterol significantly reduced the risk of average exacerbations by 14 percent and of severe exacerbations by 28 percent .