TREATMENT OF CHILDREN AND YOUNG-ADULTS WITH EARLY-STAGE NON-HODGKINS-LYMPHOMA

Background Children and young adults with early-stage non-Hodgkin's ly mphoma have an excellent prognosis, but treatment is prolonged and is associated with many side effects. We performed two studies to determi ne whether therapy could be simplified. Methods Between 1983 and 1991, we conducted two consecutive trials in children and young adults (age , <21 years) with early-stage non-Hodgkin's lymphoma. In the first tri al, patients were treated for 9 weeks with induction chemotherapy cons isting of vincristine, doxorubicin, cyclophosphamide, and prednisone, followed by 24 weeks of continuation chemotherapy with mercaptopurine and methotrexate. Half the patients were randomly assigned to receive involved-field irradiation. In the second trial, after the 9 weeks of induction chemotherapy, the patients were randomly assigned to receive 24 weeks of continuation chemotherapy or no further therapy. Results A total of 340 patients were enrolled in the two trials, 12 of whom di d not have complete remissions. One hundred thirteen patients received nine weeks of chemotherapy without radiotherapy, 131 received eight m onths of chemotherapy without radiotherapy, and 67 received eight mont hs of chemotherapy with radiotherapy. At five years, the projected rat es of continuous complete remission were 89, 86, and 88 percent for th e three groups, respectively. At five years, event-free survival among the patients with early-stage lymphoblastic lymphoma was inferior to that among the patients with other subtypes of lymphoma (63 percent vs . 88 percent, P<0.001). Continuation therapy was effective only in pat ients with lymphoblastic lymphoma. Conclusions A nine-week chemotherap y regimen without irradiation of the primary sites of involvement is a dequate therapy for most children and young adults with early-stage, n onlymphoblastic non-Hodgkin's lymphoma. (C) 1997, Massachusetts Medica l Society.