Comparison of long-term outcome of children and adolescents with disseminated non-lymphoblastic non-Hodgkin lymphoma treated with COMP or daunomycin-COMP: A report from the Children's Cancer Group

Background. Early Children's Cancer Group (CCG) trials indicated that the c yclophosphamide, vincristine, methotrexate, and prednisone (COMP) regimen w as superior to the LSA(2)L(2) regimen for non-lymphoblastic (NLB) non-Hodgk in lymphoma (NHL). Studies by other groups suggested that addition of anthr acyclines to standard therapies could improve outcome. Therefore, in 1983 C CG initiated study CCG-503, a randomized trial of COMP vs. daunomycin-COMP (D-COMP) in children and adolescents with disseminated NLB NHL. Procedures. Between December 1983 and April 1990, 404 eligible patients were entered. Patients without central nervous system (CNS) or marrow involvement were ra ndomized to receive COMP (N = 139) or D-COMP (N = 145). Randomization was s tratified by histology and site of disease. Patients with CNS or marrow inv olvement (stage IV) were nonrandomly treated with D-COMP (N = 120). Results , Ten-year event-free survival in COMP and D-COMP patients was similar: 55 +/- 4.3% (Estimate:LSE) vs. 57 +/- 4.2% (not significant), Stage I-III pati ents with large-cell (LC) NHL had worse 10-year event-free survival (EFS) ( 48 +/- 4.9%) than those with small non-cleaved cell (SNCC) NHL disease (61 +/- 3.5%, P < 0.05 in multivariate analysis), but equivalent survival (65 /- 4.7% vs. 63 +/- 3.5%) due to significantly higher salvage rates in LC pa tients, especially those failing more than 12 months from diagnosis. Ten-ye ar EFS in stage IV patients was 39 +/- 5.2%. Addition of daunomycin resulte d in higher rates of grade 3/4 hematologic toxicity and stomatitis, as well as late cardiac-related deaths. The incidence of second malignant neoplasm s was 1.0% at 10 years. Conclusions. Addition of daunomycin to standard COM P therapy did not improve outcome in pediatric disseminated NLB NHL. Patien ts with LC disease had a significantly reduced long-term EFS, but were retr ieved at a higher rate than patients with SNCC disease, resulting in equiva lent long-term survival. (C) 2001 Wiley-Liss, Inc.