Abstract
NHL's of children are a heterogeneous group of malignancies which when disseminated respond poorly to therapy. In CCSG 551, a stratified prospective trial for children with NHL, we randomized 314 patients to receive 4 drugs (COMP) or 10 drugs (modified LSA2L2). All patients received radiation to bulk disease and prophylactic IT methotrexate. Patients were grouped by extent of disease (regional vs. disseminated), and histologic type (lymphoblastic vs. non-lymphoblastic). Of the 60 patients with regional disease, 85% remained free of disease at 24 mos, regardless of histology or treatment arm. Of the 254 patients with disseminated disease, 76% of those with lymphoblastic histology remained disease free at 18 months using 10 drugs while only 36% were still in 1st remission on the 4 drug protocol (p < 0.05). In contrast, 61% of those patients with non-lymphoblastic morphology remained in 1st remission at 18 mos on 4 drugs, but only 29% were still in 1st remission using 10 drugs (p 0.05). As the overall toxicity of the 10 drug protocol exceeded that of the 4 drug protocol, we now treat all patients with regional disease with local irradiation and the 4 drug protocol. For patients with disseminated disease the 10 drug protocol is superior for lymphoblastic disease while the 4 drug is advantageous for other histologies.
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Chilcote, R., Jenkin, D., Anderson, J. et al. 800 A THERAPEUTIC TRIAL OF 10 DRUGS VS. 4 DRUGS IN NON-HODGKIN'S LYMPHOMA (NHL). Pediatr Res 15 (Suppl 4), 575 (1981). https://doi.org/10.1203/00006450-198104001-00824
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DOI: https://doi.org/10.1203/00006450-198104001-00824