COMPARISON OF TREATMENT REGIMENS FOR PEDIATRIC LYMPHOBLASTIC NON-HODGKINS-LYMPHOMA - A CHILDRENS CANCER GROUP-STUDY

Purpose: Patients with lymphoblastic non-Hodgkin's lymphoma (LB NHL) w ere randomized to treatment with either modified LSA(2)L(2) or ADCOMP, which added daunorubicin (DAUN) and asparaginase (L-ASP) to the metho trexate (MTX), cyclophosphamide (CYT), vincristine (VCR), and predniso ne (PRED) (COMP) regimen, in a clinical trial to determine the relativ e effectiveness and toxicity of the two regimens. Patients and Methods : Patients with LB NHL were eligible for this randomized study if they were less than 22 years of age at diagnosis and had less than or equa l to 25% blasts in the bone marrow. Of 307 patients registered, 281 we re fully eligible and assessable. Patients were stratified by extent o f disease at diagnosis. Results: The 5-year event-free survival (EFS) rate for patients with localized disease was 84%, and for patients wit h disseminated disease, 67%. There were four relapses in 28 patients w ith localized disease. Two hundred six patients had mediastinal primar y tumors and despite local radiation, 34 of 63 failures in these patie nts involved the primary tumor site with or without other involvement. After adjusting for extent of disease at diagnosis, the regimens did not differ significantly with respect to risk for adverse events. The acute toxicity was primarily neutropenia and thrombocytopenia, with gr eater initial toxicity in patients on the LSA(2)L(2) regimen. Three pa tients developed acute myelogenous leukemia. Conclusion: Long-term EFS in children with LB NHL can be achieved in the majority of patients. Disease progression, which includes recurrence at the primary tumor si te, is a major cause of treatment failure in patients with mediastinal presentations. Addition of DAUN and L-ASP to the COMP regimen does no t produce a more effective treatment than LSA(2)L(2). (C) 1995 by Amer ican Society of Clinical Oncology.