Stage III abdominal non‐Hodgkin's lymphoma in costa rican children: Comparison of two consecutive trials of treatment

Abstract

Seventy-three patients with Stage III abdominal non-Hodgkin's lymphoma were prospectively treated following two sequential protocols (P): L278 P (group A, 33 patients) (1978-1983) and L384 P (group B, 40 patients), (1984-1991). No patient received radiotherapy. The L278 P included 7 drugs: cyclophosphamide, vincristine (VCR), adriamycin (ADR), prednisone, methotrexate (MTX), dexamethasone, and 6-mercaptopurine, given for remission induction, maintenance, and CNS prophylaxis. In the L384 P we introduced a consolidation phase consisting of intravenous MTX and citrovorum factor rescue, and IV cytosine arabinoside. VCR was also added to the monthly doses and the maintenance phase was reduced from 18 to 15 months. From January 1988 we changed ADR for epirubicin in the same doses. Prophylactic treatment of the CNS, in the L384 P, was intensified by increasing the number of doses of MTX IT in the remission, induction, and consolidation phases, and with the use of ara-C IT. Laparotomy in 50 patients allowed partial resection in 16, and second-look laparotomy was performed in 27 patients. Viable tumor was found in four patients. Three patients (G-A) died from metabolic complications and another 4 (2 G-A and 2 G-B) failed to attain CR and died. A total of 28 (85%) of 33 children of G-A and 38 (95%) of 40 children in G-B achieved CR. Five children died in remission (2 G-A, 3 G-B). Three patients (G-A) relapsed in the CNS and one (G-B) relapsed in the abdomen and died. Disease-free survival at 120 months was 70% in G-A and 84% in G-B.

Results of a BFM-based protocol for the treatment of childhood B-non-Hodgkin's lymphoma and B-Acute lymphoblastic leukemia in Argentina

“…In most studies from developed countries, the median age of these patients is 8 to 10 years [3,18,19]. In addition, it was suggested that children with B-NHL from Latin American countries present more frequently with an abdominal primary tumor [16]. Our patient population mostly lived in temperate areas, and seem to resemble more closely to that reported from developed countries, since both age and primary tumor distribution are comparable to most reports from these countries [3,18,19].…”

“…Moreover, children with small non-cleaved cell lymphoma from tropical areas in Latin America also show different molecular features from children from temperate areas [15]. The median age for presentation of B-NHL is around 4 years in these countries [16,17]. In most studies from developed countries, the median age of these patients is 8 to 10 years [3,18,19].…”

“…The clinical and molecular features of B-NHL in latin american children seem to be different from that of patients in Europe or the United States [15]. It has been reported that the response to moderately intense chemotherapy and overall survival are better in tropical Latin American countries [16,17]. Moreover, children with small non-cleaved cell lymphoma from tropical areas in Latin America also show different molecular features from children from temperate areas [15].…”