title: Shortened intensified multi-agent chemotherapy and non-cross resistant maintenance therapy for advanced lymphoblastic lymphoma in children and adolescents: report from the Children's Oncology Group.
abstract: Pediatric lymphoblastic lymphoma (LL) has utilized treatment strategies similar to childhood acute lymphoblastic leukaemia (ALL) with prolonged maintenance chemotherapy. We report the results of a pilot study to estimate the feasibility, toxicity and efficacy of a 12-month aggressive multi-agent chemotherapy regimen in children and adolescents with advanced LL. Between July 1994 and June 1997, 85 eligible children and adolescents with advanced LL (Stage III/IV) were enrolled on this pilot study. Patients achieving a complete response following induction and consolidation received six cycles of maintenance chemotherapy for a total duration of 12 months. Grade III/IV toxicities included: hematological (80%), infections (20%), stomatitis and elevated transaminases, (29%). There were a total of 19 events, 13 relapses, two secondary acute myeloid leukaemia and four toxic deaths (5%). The 5-year event-free survival (EFS) and overall survival (OS) was 78 +/- 4.5% and 85 +/- 3.9%, respectively. Relapsed patients had a 5-year OS of only 33 +/- 14%. Multivariate analysis failed to demonstrate age, gender, lactate dehydrogenase level, presence of marrow and/or central nervous system disease to have independent prognostic value. These results suggest that this experimental approach is safe and results in similar outcomes as more prolonged childhood ALL regimens.
authors.affiliation: Department of Pediatrics Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE 68198-2168, USA. mabromow@unmc.edu
authors.forename: Minnie
authors.initials: M
authors.lastname: Abromowitch
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.forename: Sherrie
authors.initials: S
authors.lastname: Perkins
authors.forename: David
authors.initials: D
authors.lastname: Zwick
authors.forename: Stuart
authors.initials: S
authors.lastname: Siegel
authors.forename: Jonathan
authors.initials: J
authors.lastname: Finlay
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo