PRELIMINARY-REPORT OF AN INTENSIFIED, SHORT-DURATION CHEMOTHERAPY PROTOCOL FOR THE TREATMENT OF PEDIATRIC NON-HODGKINS-LYMPHOMA IN INDIA

Background: In the past, the results of the treatment of nonHodgkin's lymphomas (NHL) in Indian children have been poor, due to inadequate c hemotherapy and poor supportive care. In an attempt to overcome these problems, we conducted a clinical trial in Bombay with a new protocol, MCP842. Patients and methods: Seventy-four previously untreated patie nts <25 years were entered on study at the Tata Memorial Hospital, Bom bay. Patients with lymphoblastic lymphoma (LL) (38) without bone marro w involvement and all patients with small noncleaved cell lymphoma (SN CL) (18) and large cell lymphoma (LCL) (18) were eligible. Treatment c onsisted of alternating cycles of two regimens, A and B. Patients with SI. Jude stages I and II received six cycles, and those with stages I II or IV received eight cycles. A cycles included cyclophosphamide, ad riamycin, vincristine and ara-C, and B cycles, etoposide, vincristine, methotrexate, ifosfamide and mesna. Results: Complete response was ac hieved in 67 (91%) of patients. Event free survival (EFS) for all pati ents was 58%; 68% for patients with SNCL and LCL combined, and 48% for patients with LL. There was no significant difference in EFS by histo logy (LL ver sus non-LL), or stage. There were nine (12%) toxic deaths , two during induction and seven in patients in remission; six occurre d in patients with LL. Conclusions. These results are better than past results in Bombay. Unlike earlier CCG protocols, in which the outcome between patients with LL and non-LL differed, this was not so in MCP8 42. Even patients with extensive LL without bone marrow disease receiv ed only eight cycles of therapy, suggesting that short duration therap y is curative in as many as half of such patients - an important obser vation in a country with limited resources.