THERAPY OF NON-B-CELL MALIGNANT NON-HODGK INS-LYMPHOMA OF CHILDHOOD AND ADOLESCENCE - AN INTERIM ANALYSIS OF STUDY NHL-BFM-90 .2.

The goals of study NHL-BFM 90 for the therapy group Non-B NHL are to p rospectively evaluate the dynamic of tumor regression and the persiste nce of a residual mass after induction therapy for its prognostic impa ct. Patients (pts) of stages I and II receive induction composed of pr ednisone, vincristin (VCR), daunorubicin, L-asparaginase (L-ASP), cycl ophosphamide (CP), cytarabin (ARA-C), 6-mercaptopurin (6-MP) and intra thecally (i.th.) methotrexate (MTX), followed by consolidation (6-MP, MTX 5 g/m2 x 4, MTX i. th.), and maintenance up to 24 months. Pts of s tages III and IV receive additionally reinduction (Dexamethasone, VCR, doxorubicin, L-ASP. CP, ARA-C, 6-thioguanin, MTX i.th.) and cranial i rradiation. Pts with < 70% tumor regression at day 33 of induction rec eive an intensified chemotherapy. Pts with > 70% tumor regression at d ay 33 but a persistent mass at the end of induction have a surgical re section. Pts with a completely necrotic residual mass continue with co nsolidation therapy. Pts with active residual lymphoma receive an inte nsified chemotherapy. No local radiotherapy is given. From 4/1990 to 1 2/1992, 80 pts were registered; 71 pts are evaluable for response. The distribution of stages is as follows: 6, 1, 47, 17 pts of stage I. II , III, IV, respectively. The probability of event free survival at 3 y ears is 87 +/- 4% for the whole group (median observation time 21 mont hs). 66 pts are evaluable for the dynamic of response. Of 49 pts with complete tumor regression until day 33, 3 suffered from relapse; of 3 pts with < 70% tumor regression at day 33, 2 suffered from progress su bsequently; of 14 pts with incomplete but > 70% tumor regression at da y 33 none suffered from progress subsequently; 6 of them had a residua l mass after completion of induction. A resection or biopsy was done i n 3 patients which revealed active lymphoma in one case. Our prelimina ry conclusions are: 1) The extent of tumor regression at day 33 ist pr obably more important than persistence of a residual mass after comple tion of induction. However. final conclusions need more evaluable pts. 2) The data justify to continue with the treatment strategy for pts w ith a residual mass after completion of induction therapy excluding lo cal radiotherapy.