Combination of dexamethasone, high-dose cytarabine, and carboplatin is effective for advanced large-cell non-Hodgkin lymphoma of childhood.
BACKGROUND
The purpose of the current study was to evaluate the activity and toxicity of dexamethasone, high-dose cytarabine, and carboplatin (DAC) combination therapy in children with newly diagnosed large-cell non-Hodgkin lymphoma (NHL) and to estimate the event-free and overall survival rates achieved when DAC is incorporated into a conventional regimen.


METHODS
From 1991 to 1997, 20 boys and 5 girls aged 4.2 to 17.7 years who had stage III (according to the St. Jude staging system) (n = 21) or stage IV (n = 4) large-cell NHL were treated in this study. DAC therapy was administered at the beginning of the induction phase in 2 sequential cycles and incorporated throughout a continuation phase (modified from the ACOP+ regimen, which features doxorubicin, cyclophosphamide, vincristine, and prednisone) with doxorubicin, cyclophosphamide, vincristine, and dexamethasone. The total duration of treatment was approximately 10 months.


RESULTS
DAC therapy yielded a response in 22 of 25 patients (88%; 95% confidence interval [95% CI], 68%-97%): complete remission in 13 cases (52%), and partial response in 9 (36%). After additional treatment with doxorubicin, cyclophosphamide, vincristine, and dexamethasone, complete remission was attained in 18 patients (72%) and partial remission in 3 (12%). The event-free survival rate (+/- the standard error [SE]) was 64% +/- 9% and the overall survival rate was 80% +/- 8% at 5 years.


CONCLUSIONS
The results of the current study indicate that the DAC regimen is well tolerated and effective for pediatric patients with large-cell NHL.
Sandlund
John T
JT
Department of Hematology-Oncology, St. Jude Children's Research Hospital, the University of Tennessee at Memphis College of Medicine, Memphis, Tennessee 38105, USA. John.Sandlund@stjude.org
Santana
Victor M
VM
Hudson
Melissa M
MM
Onciu
Mihaela
M
Head
David
D
Murry
Daryl J
DJ
Ribeiro
Raul
R
Wallace
Dana
D
Rencher
Renee
R
Pui
Ching-Hon
CH
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003561:Cytarabine / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008297:Male; D015996:Survival Rate
D003561:Cytarabine; D003907:Dexamethasone; D016190:Carboplatin