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

被引:22
作者
Sposto, R
Meadows, AT
Chilcote, RR
Steinherz, PG
Kjeldsberg, C
Kadin, ME
Krailo, MD
Termuhlen, AM
Morse, M
Siegel, SE
机构
[1] Univ So Calif, Keck Sch Med, Los Angeles, CA USA
[2] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA
[3] Univ Calif Irvine, Irvine, CA USA
[4] Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA
[5] Univ Utah, Med Ctr, Salt Lake City, UT USA
[6] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
[7] Columbus Childrens Hosp, Columbus, OH USA
[8] Childrens Hosp Denver, Denver, CO USA
[9] Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA
来源
MEDICAL AND PEDIATRIC ONCOLOGY | 2001年 / 37卷 / 05期
关键词
pediatric cancers; non-Hodgkin lymphoma; cancer survival; randomized trials;
D O I
10.1002/mpo.1226
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background. Early Children's Cancer Group (CCG) trials indicated that the cyclophosphamide, vincristine, methotrexate, and prednisone (COMP) regimen was superior to the LSA(2)L(2) regimen for non-lymphoblastic (NLB) non-Hodgkin lymphoma (NHL). Studies by other groups suggested that addition of anthracyclines to standard therapies could improve outcome. Therefore, in 1983 CCG 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 randomized to receive COMP (N = 139) or D-COMP (N = 145). Randomization was stratified by histology and site of disease. Patients with CNS or marrow involvement (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 patients 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 patients, especially those failing more than 12 months from diagnosis. Ten-year EFS in stage IV patients was 39 +/- 5.2%. Addition of daunomycin resulted in higher rates of grade 3/4 hematologic toxicity and stomatitis, as well as late cardiac-related deaths. The incidence of second malignant neoplasms was 1.0% at 10 years. Conclusions. Addition of daunomycin to standard COMP therapy did not improve outcome in pediatric disseminated NLB NHL. Patients with LC disease had a significantly reduced long-term EFS, but were retrieved at a higher rate than patients with SNCC disease, resulting in equivalent long-term survival. (C) 2001 Wiley-Liss, Inc.
引用
收藏
页码:432 / 441
页数:10
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