Journal of Clinical Oncology, Vol 4, 1219-1226, Copyright © 1986 by American Society of Clinical Oncology
Improved survival rate in children with stage III and IV B cell non- Hodgkin's lymphoma and leukemia using multi-agent chemotherapy: results of a study of 114 children from the French Pediatric Oncology Society
C Patte, T Philip, C Rodary, A Bernard, JM Zucker, JL Bernard, A Robert, X Rialland, E Benz-Lemoine and F Demeocq
Children with B cell non-Hodgkin's lymphoma who have not relapsed 1 year
after diagnosis and treatment are generally cured. We report here the
results of treatment in 114 children who all had a minimum follow- up of 20
months. The protocol LMB 0281 from the French Pediatric Oncology Society
was used. This nine-drug intensive-pulsed chemotherapy was based on
high-dose cyclophosphamide, high-dose methotrexate (HD MTX), and cytosine
arabinoside (ara-C) in continuous infusion. CNS prophylaxis was with
chemotherapy only. No local irradiation was performed. No debulking surgery
was recommended. There were 72 patients with stage III lymphoma and 42
patients with stage IV lymphoma or B cell acute lymphocytic leukemia
(B-ALL). Among those 42 patients, seven had CNS involvement alone, 21 had
bone marrow alone, and 14 had both; 26 had greater than 25% blast cells in
bone marrow, 14 of whom had blast cells in blood. The primary site of
involvement was the abdomen in 90 patients, the Waldeyer Ring in nine, and
various sites in eight; seven patients presented without tumor.
Seventy-seven patients are alive with a median follow-up of 2 years and 8
months. Seven patients died due to initial treatment failure, 11 died from
toxicity, and 19 died after relapse. Among the 93 patients without initial
CNS involvement, only one isolated relapse in CNS occurred. Survival and
disease-free survival rates reached 67% and 64%, respectively, for all
patients, 75% and 73% for stage III patients and 54% and 48% for stage IV
and B-ALL patients. Bone marrow involvement was not an adverse prognostic
factor. Contrary initial CNS involvement indicated a bad prognosis with a
disease-free survival rate of 19% compared with 76% without CNS disease.
This study showed that CNS prophylaxis and local control of the primary
tumor can be achieved by intensive chemotherapy alone, without radiotherapy
or debulking surgery.
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