With improved survival of neuroblastoma in recent years, chances of developing recurrences in unusual sites are not uncommon. Brain and gonads are increasingly being reported as sites of involvement with neuroblastoma. This article reviews the significance of brain parenchymal involvement in neuroblastoma and the treatment results.

Acute Lymphoblastic leukemia(ALL) constitutes one of the commonest malignancies in the pediatric group. A total of 163 patients age upto and inclusive of 14 years were treated with MCP 841 protocol between 1983 and 1992, 132(81 percent) achieved complete remission(CR). Of the 132 complete responders, 50(37.9 percent) relapsed ON THERAPY and 78 percent had salvage treatment with an intensive MCP 841 relapse protocol and they form the study Bone marrow relapse(74.3 Percent) was the predominant site. The isolated bone marrow, CNS and testicular relapse was 53.8 percent, 7.7 percent and 17.9 percent respectively. 18(46.2 percent) achieved second CR and remaining 21 had progressive disease and died. Among the 18 second CR 13 had second relapse. The remaining 5 year event free and relapse free survival was 15.4 and 33.3 percent respectively among the salvaged patients. The EFS of bone marrow, CNS and testicular relapse was 12.5 percent, 12.5 percent and 28.6 percent and RFS was 37.5 percent, 25 percent and 33.3 percent respectively.

Acute promyelocytic leukemia(APL) is a distinct subtype of myeloid leukemia characterised by abundant abnormal promyelocytes in the peripheral blood and bone marrow: a reciprocal and balanced translocation and differentiation of abnormal promyelocytes using all trans retinoic acid(ATRA). However in 30 patients the use of ATRA is associated with a rapid increase in leucocytes and retinoic acid syndrome. Between February 1992 and December 1996, 52 consecutive patients of newly diagnosed patients of APL were treated with ATRA. Between day r and day 26 of treatment. 15 of the 52 patients developed a distinctive symptom complex chiefly characterised by fever and dyspnea. Chest radiograph in all these patients showed bilateral pulmonary infiltrates. The other clinical findings were hyperleukocytosis, mild renal insufficiency, mild hyperbilirubenemia, ascites, plueral effusion and splenic infract. These patients were treated with hydroxyurea for hyperleukoctosis and intravenous dexamethasone 10 mg. twice daily for atleast three days. ATRA was continued in all the patients. Eight of these 15 patients showed good clinical response to addition of steroids and achieved complete response. Seven patients however succumbed to retinoic acid syndrome secondary to pulmonary hemorrhage, progressive respiratory distress and sepsis. The initial peripheral blood counts did not predict which patients were at risk.