Preliminary report of an intensified, short duration chemotherapy protocol for the treatment of pediatric non-Hodgkin's lymphoma in India

• Published in: Annals of oncology Vol. 8; no. 9; pp. 893 - 897
• Main Authors: Advani, S., Pai, S., Adde, M., Vaidya, S., Vats, T., Naresh, K., Kurkure, P. A., Nair, C. N., Venzon, D., Margrath, I.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.09.1997
• Subjects: Adolescent; Adult; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Chemotherapy; Child; Child, Preschool; childhood; Female; Humans; India; lymphoblastic; Lymphoma, Non-Hodgkin - drug therapy; Male; Medical sciences; non-Hodgkin's lymphoma; Pharmacology. Drug treatments; small noncleaved; treatment; Asia; India; Human; Antineoplastic agent; Chemotherapy; Treatment; Toxicity; Lymphoproliferative syndrome; Clinical trial; Malignant hemopathy; Non Hodgkin lymphoma; Child
• ISSN: 1569-8041; 0923-7534; 1569-8041
• DOI: 10.1023/A:1008228529397

Background: In the past, the results of the treatment of non- Hodgkin's lymphomas (NHL) in Indian children have been poor, due to inadequate chemotherapy and poor supportive care. In an attempt to overcome these problems, we conducted a clinical trial in Bombay with a new protocol, MCP842. Patients and methods: Seventy-four previously untreated patients <25 years were entered on study at the Tata Memorial Hospital, Bombay. Patients with lymphoblastic lymphoma (LL) (38) without bone marrow involvement and all patients with small noncleaved cell lymphoma (SNCL) (18) and large cell lyrnphoma (LCL) (18) were eligible. Treatment consisted of alternating cycles of two regimens, A and B. Patients with St. Jude stages I and II received six cycles, and those with stages III or IV received eight cycles. A cycles included cyclophos phamide, adriamycin, vincristine and ara-C, and B cycles, etoposide, vincristine, methotrexate, ifosfamide and mesna. Results: Complete response was achieved in 67 (91%) of patients. Event free survival (EFS) for all patients was 58%; 68% for patients with SNCL and LCL combined, and 48% for patients with LL. There was no significant difference in EFS by histology (LL versus non-LL), or stage. There were nine (12%) toxic deaths, two during induction and seven in patients in remission; six occurred in patients with LL. Conclusions: These results are better than past results in Bombay. Unlike earlier CCG protocols, in which the outcome between patients with LL and non-LL differed, this was not so in MCP842. Even patients with extensive LL without bone marrow disease received only eight cycles of therapy, suggest ing that short duration therapy is curative in as many as half of such patients - an important observation in a country with limited resources.