Abstract |
Despite prolonged therapy (18 months), children with advanced non-lymphoblastic, non-Hodgkin's lymphoma (NHL) treated on previous Children's Cancer Group (CCG) trials achieved less than a 60% 5-year event-free survival (EFS). In this study we piloted a shorter but more intensive protocol ('Orange') to determine the feasibility, safety, and efficacy of this alternative treatment approach. Thirty-nine children received a CHOP-based induction, etoposide/ ifosfamide consolidation, DECAL ( dexamethasone, etoposide, cisplatin, cytosine arabinoside ( Ara-C) and L- asparaginase) intensification, and either one or two similar but less intense maintenance courses. Patients were stratified to standard-risk (5 months) vs high-risk (7 months) treatment. High risk was defined as either bone marrow disease, CNS disease, mediastinal mass > or = one-third thoracic diameter at T5 and/or LDH > or =2 times institutional upper limits of normal. All other patients were considered to be standard risk. Results were compared with the previous CCG NHL study (CCG-503). Sixteen and 23 patients were considered standard- vs. high-risk, respectively. The 5-year EFS and overall survival (OS) were 77 +/- 7% and 80 +/- 7%, respectively. The 5-year EFS and OS were significantly better in the standard- vs. high-risk subgroups (100% vs. 61 +/- 11%) (P < 0.003) and (100% vs. 65 +/- 11%) (P < 0.01), respectively. Lactate dehydrogenase (LDH) > or =2 x normal (NL) was associated with significantly poorer outcomes (LDH > or =2 x NL vs. <2 x NL) (5-year EFS: 55 +/- 12% vs. 100%) (P < 0.0004). This CCG hybrid regimen, 'Orange', of short and more intensive therapy resulted in a significant improvement in outcomes compared with the previous CCG trial of more prolonged but less intense therapy. This regimen that deletes high-dose methotrexate, if confirmed in a larger trial, could be considered as an alternative treatment approach in children without high tumor burdens ( LDH <2 x NL) and Murphy stage III disease.
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Authors | M S Cairo, M D Krailo, M Morse, R J Hutchinson, R E Harris, C R Kjeldsberg, M E Kadin, E Radel, L J Steinherz, E Morris, J L Finlay, A T Meadows |
Journal | Leukemia
(Leukemia)
Vol. 16
Issue 4
Pg. 594-600
(Apr 2002)
ISSN: 0887-6924 [Print] England |
PMID | 11960338
(Publication Type: Clinical Trial, Clinical Trial, Phase II, Journal Article, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
- L-Lactate Dehydrogenase
- Methotrexate
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Topics |
- Adolescent
- Adult
- Antineoplastic Combined Chemotherapy Protocols
(therapeutic use)
- Child
- Child, Preschool
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- L-Lactate Dehydrogenase
(metabolism)
- Lymphoma, Non-Hodgkin
(drug therapy, enzymology, pathology)
- Male
- Methotrexate
(administration & dosage)
- Neoplasm Staging
- Pilot Projects
- Prognosis
- Treatment Outcome
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