RESULTS OF A BFM-BASED PROTOCOL FOR THE TREATMENT OF CHILDHOOD B-NON-HODGKINS LYMPHOMA AND B-ACUTE LYMPHOBLASTIC-LEUKEMIA IN ARGENTINA

Purpose. To report the feasibility and results of a study based on the BFM-ALL-NHL/86 protocol for B-non-Hodgin's Lymphoma (NHL) and B-Acute Lymphoblastic Leukemia (B-ALL) in Argentina. Design. Prospective, sin gle arm, non-randomized trial. Patients and Methods. From August 1988 to December 1993, 87 consecutive patients with B-NHL/B-ALL were admitt ed and 82 were eligible. The therapy was stratified according to stage . All patients received a cytoreductive prephase with cyclophosphamide and prednisone. Those with stage I-II were treated with three 5-day b locks of combined intense chemotherapy including dexamethasone, cyclop hosphamide, ifosfamide, cytarabine, teniposide, doxorubicin, and 500 m g/m(2) of methotrexate as a 24 hour continuous infusion. Stage III rec eived 6 blocks and those with stage IV/B-ALL received 6 intensified bl ocks in which 2 g/m(2) of 24 hour continuous infusion methotrexate and vincristine were added. Triple intrathecal therapy was given for CNS prevention. After the first two blocks the response was assessed and t hose with a partial response were offered optionallya second look surg ery or local radiotherapy. Results. With a median follow-up of 38 (ran ge 16-71) months, the event-free survival (pEFS) for the whole group w as 0.69 (Stage I-II n = 16 pEFS = 0.94, stage III n = 50 pEFS = 0.66, Stage IV n = 7 pEFS = 0.43, B-ALL n = 9 pEFS = 0.66). Patients with st age III abdominal tumors who achieved a partial response by imaging st udies after induction had a significantly higher risk of relapse than those with a complete response (p = 0.02). Relapse was the most freque nt event Toxicity was mainly hematological. Conclusions. The applicati on of this protocol was feasible in our setting and its results compar able to the German study. Patients with stage I-II had an excellent ou tcome. Those with stage III and B-ALL achieved an encouraging event-fr ee survival, however those with abdominal tumors and partial response to induction chemotherapy fared less favourably. This strategy was les s effective for patients with initial CNS disease. (C) 1997 Wiley-Liss , Inc.