Anderson J R, Jenkin R D, Wilson J F, Kjeldsberg C R, Sposto R, Chilcote R R, Coccia P F, Exelby P R, Siegel S, Meadows A T
University of Nebraska Medical Center, Omaha.
J Clin Oncol. 1993 Jun;11(6):1024-32. doi: 10.1200/JCO.1993.11.6.1024.
We analyzed the long-term results of a Childrens Cancer Group (CCG) randomized study comparing cyclophosphamide, vincristine, methotrexate, and prednisone (COMP) versus LSA2L2 as treatment for childhood non-Hodgkin's lymphoma. The initial results were previously reported (N Engl J Med 308:559, 1983).
A total of 429 patients are reported here, 68 with localized disease and 361 with disseminated disease. The distribution of disseminated-disease patients by histologic type was 164 lymphoblastic, 60 large-cell, and 137 undifferentiated lymphomas. Median follow-up duration of surviving patients is 8 years.
Event-free survival (EFS) of patients with localized disease was 84% at 5 years. No differences were seen between the two treatment regimens. Results for patients with disseminated disease was dependent on histologic subtype: patients with lymphoblastic lymphoma did better when treated with LSA2L2 (5-year EFS of 64% v 35% for COMP); COMP produced better results for patients with undifferentiated lymphoma (5-year EFS of 50% v 29% for LSA2L2). Results for large-cell lymphoma patients were similar (5-year EFS of 52% for COMP v 43% for LSA2L2). Five percent of patients died of treatment-related complications while on therapy (primarily infections). Only four deaths without progression have been observed off-therapy (two from restrictive lung disease, one from an acute asthma attack, one from colon cancer). Patient survival rates after recurrence were poor.
Treatment success can be expected in 84% of pediatric patients with localized non-Hodgkin's lymphoma. For patients with disseminated disease, treatment success can be expected in 64% of those with lymphoblastic and 50% of those with undifferentiated or large-cell disease. To date, late adverse events are rare.
我们分析了儿童癌症研究组（CCG）的一项随机研究的长期结果，该研究比较了环磷酰胺、长春新碱、甲氨蝶呤和泼尼松（COMP）与LSA2L2作为儿童非霍奇金淋巴瘤治疗方案的疗效。初步结果此前已有报道（《新英格兰医学杂志》308:559，1983）。
本文共报告了429例患者，其中68例为局限性疾病，361例为播散性疾病。播散性疾病患者按组织学类型分布为164例淋巴母细胞性、60例大细胞性和137例未分化淋巴瘤。存活患者的中位随访时间为8年。
局限性疾病患者的无事件生存率（EFS）在5年时为84%。两种治疗方案之间未观察到差异。播散性疾病患者的结果取决于组织学亚型：淋巴母细胞性淋巴瘤患者接受LSA2L2治疗效果更好（5年EFS为64%，而COMP为35%）；COMP对未分化淋巴瘤患者效果更好（5年EFS为50%，而LSA2L2为29%）。大细胞淋巴瘤患者的结果相似（COMP的5年EFS为52%，LSA2L2为43%）。5%的患者在治疗期间死于与治疗相关的并发症（主要是感染）。在停止治疗后仅观察到4例无病情进展的死亡（2例死于限制性肺病，1例死于急性哮喘发作，1例死于结肠癌）。复发后患者的生存率很低。
预计84%的局限性非霍奇金淋巴瘤儿科患者治疗成功。对于播散性疾病患者，预计64%的淋巴母细胞性疾病患者和50%的未分化或大细胞性疾病患者治疗成功。迄今为止，晚期不良事件很少见。
