STAGE-III ABDOMINAL NON-HODGKINS-LYMPHOMA IN COSTA-RICAN CHILDREN - COMPARISON OF 2 CONSECUTIVE TRIALS OF TREATMENT

Seventy-three patients with Stage III abdominal non-Hodgkin's lymphoma were prospectively treated following two sequential protocols (P): L2 78 P (group A, 33 patients) (1978-1983) and L384 P (group B, 40 patien ts), (1984-1991). No patient received radiotherapy. The L278 P include d 7 drugs: cyclophosphamide, vincristine (VCR), adriamycin (ADR), pred nisone, methotrexate (MTX), dexamethasone, and 6-mercaptopurine, given for remission induction, maintenance, and CNS prophylaxis. In the L38 4 P we introduced a consolidation phase consisting of intravenous MTX and citrovorum factor rescue, and IV cytosine arabinoside. VCR was als o added to the monthly doses and the maintenance phase was reduced fro m 18 to 15 months. From January 1988 we changed ADR for epirubicin in the same doses. Prophylactic treatment of the CNS, in the L384 P, was intensified by increasing the number of doses of MTX IT in the remissi on, induction, and consolidation phases, and with the use of ara-C IT. Laparotomy in 50 patients allowed partial resection in 16, and second -look laparotomy was performed in 27 patients. Viable tumor was found in four patients. Three patients (G-A) died from metabolic complicatio ns and another 4 (2 G-A and 2 G-B) failed to attain CR and died. A tot al of 28 (85%) of 33 children of G-A and 38 (95%) of 40 children in G- B achieved CR. Five children died in remission (2 G-A, 3 G-B). Three p atients (G-A) relapsed in the CNS and one (G-B) relapsed in the abdome n and died. Disease-free survival at 120 months was 70% in G-A and 84% in G-B. (C) 1994 Wiley-Liss, Inc.