Poor-risk non-lymphoblastic lymphoma of childhood: Results of an intensive pilot study
- 1 January 1989
- journal article
- research article
- Published by Wiley in Medical and Pediatric Oncology
- Vol. 17 (1) , 29-38
- https://doi.org/10.1002/mpo.2950170107
Abstract
Children with “poor-risk” nonlymphoblastic lymphoma, especially those with marrow or nervous system (CNS) involvement at presentation, have fared poorly even on aggressive chemotherapy regimens. We report here the results of a pilot study of 30 children treated with a highly intensive chemotherapy regimen. This regimen includes an intensive Induction Phase consisting of three cycles of CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and corticosteroids) as well as intensive intrathecal therapy with each cycle. This is followed by a CNS Consolidation Phase consisting of a single cycle of CHOP therapy with five intrathecal doses of “triple” chemotherapy (methotrexate, cytosine arabinoside, and hydrocortisone). Thereafter, a Maintenance Phase consists of alternating cycles of 1) cytosine arabinoside and 6-thioguanine, 2) oral methotrexate and VP-16, and 3) CHOP, for a duration that varied from 36 to 72 wk. Neither debulking surgery nor radiation therapy were recommended. There were 20 patients with Stage III disease (St. Jude's Staging System) and an additional ten patients with bone marrow and/or CNS involvement. The latter group included six patients with B-cell leukemia, three of whom also had CNS disease at presentation. Two additional patients had CNS disease without marrow involvement. Twenty-nine of 30 patients achieved a complete response. Six patients died with recurrent or progressive disease. Twenty-three patients are alive without any adverse events between 21 and 65 mo after diagnosis, with the median time of survival not yet reached (at least 32 mo). All seven adverse events occurred within 7 mo of diagnosis. Event-free survival for all patients is 77%, for Stage III patients is 80%, and for patients with marrow and/or CNS involvement is 70%. This pilot study offers encouragement for improvement in the prognosis of children with “poor-risk” nonlymphoblastic lymphoma and merits evaluation in a Phase III randomized trial in the multicenter cooperative group setting.Keywords
This publication has 18 references indexed in Scilit:
- Results of treatment of advanced-stage Burkitt's lymphoma and B cell (SIg+) acute lymphoblastic leukemia with high-dose fractionated cyclophosphamide and coordinated high-dose methotrexate and cytarabine.Journal of Clinical Oncology, 1986
- Late recurrences of histiocytic lymphoma after treatmentCancer, 1984
- Childhood Non-Hodgkin's LymphomaNew England Journal of Medicine, 1983
- Combination chemotherapy with cyclophosphamide, vincristine, prednisone and the contribution of adriamycin in the treatment of adult non-Hodgkin's lymphomas. A report of 131 casesCancer, 1982
- Childhood non-hodgkin's lymphoma: Long-term results of an intensive chemotherapy regimenCancer, 1981
- A randomized trial of combined modality therapy of childhood non-Hodgkin's lymphomaCancer, 1980
- Treatment Results of 54 American Patients with Burkitt's Lymphoma Are Similar to the African ExperienceNew England Journal of Medicine, 1977
- Non-Hodgkin's lymphoma in children. A comparative study of two modalities of therapyCancer, 1976
- Neurotoxicity and Elevated Cerebrospinal-Fluid Methotrexate Concentration in Meningeal LeukemiaNew England Journal of Medicine, 1973
- Nonparametric Estimation from Incomplete ObservationsJournal of the American Statistical Association, 1958