IMPROVED TREATMENT RESULTS OF NON-HODGKINS-LYMPHOMA IN CHILDREN - A REPORT FROM THE CHILDRENS CANCER AND LEUKEMIA STUDY-GROUP OF JAPAN

From 1985 to 1989, 69 patients with non-Hodgkin's lymphoma (NHL) were treated by members of the Children's Cancer and Leukemia Study Group o f Japan with a protocol consisting of vincristine, prednisolone, cyclo phosphamide, doxorubicin, high-dose methotrexate (HD-MTX), mercaptopur ine and cytarabine; central nervous system (CNS) prophylaxis with intr athecal MTX and hydrocortisone (NHL855). The 4-year event-free surviva l (EFS) was 78% (S.E., 10%) for patients with localized disease (n = 1 8) and 38% (S.E., 7%) for those with advanced disease (n = 51). Among the patients with advanced disease, those with non-lymphoblastic lymph oma tended to have a better 4-year EFS than those with lymphoblastic l ymphoma (52% vs, 25%), Based on these findings, we initiated a new pro tocol NHL890 in which patients were assigned to two different chemothe rapies according to the histology. Non-lymphoblastic subtype was treat ed almost identically to NHL855 while asparaginase and VP-16 were newl y added in the consolidation-maintentance phase in advanced-stage lymp hoblastic lymphoma. Sixty-seven patients with advanced disease were as sessable. The overall 4-year EFS for advanced disease improved to 69% (S.E., 6%), A significant improvement was gained in the lymphoblastic lymphoma with a 4-year EFS of 56% (S.E., 11%) as compared with 25% (S. E., 9%) in the preceding study (P < 0.05), These findings suggest the importance of histology in the treatment of advanced-stage non-Hodgkin 's lymphoma in childhood.