superiority of high dose chemotherapeutic regimens in the treatment of pediatric Non-Hodgkin's Lymphoma: results of a retrospective non randomized study of 103 evaluable cases

This retrospective study reviewed 160 previously untreated cases of pediatric Non Hodgkin's lymphoma referred to NEMPOCK between Jan. 1985-Dec. 1993. The treatment protocol adopted for these patients were the COMP regimen for undifferentiated, [small non cleaved], diffuse mixed and large cell subtypes while lymphoblastic lymphoma and T cell immunoblastic subtypes were treated by a modification of the CHOP regimen. During the study period 2 different dose levels of the treatment regimens were used: low dose regimens [1965-1989] and high dose regimens [1990-1993]. The response rate achieved among the 103 evaluable cases was significantly infavour of the high dose regimens being 85% and 86% for the COMP and CHOP respectively versus 57% and 60% [p< 0.05] for their low dose counter parts. C.N.S. relapse was seen in 10% with no significant benefit observed in patients received prophylactic cranial irradiation compared to those who received intrathecal chemotherapy alone. Relapse was reported in 9 out of the 70 cases who achieved complete remission [41%]. The relapse rate was reduced significantly [p=0.05] in patients treated by the high dose regimens compared to those treated by the low dose regimens [32% and 49% respectively]. A median follow up period of 64 months [range 24-129 months], the overall survival was significantly superior in patients treated by the high dose regimens compared to those treated by the low dose regimens being 59% and 31% respectively [p=0.03]. The following prognostic factors were significantly associated with poor prognosis: presence of bulky disease [p=0.0001], low dose regimens [p=0.007], stage IV disease [p=0.01] and initial CNS involvement [p=0.05]

Risk factors in intermediate and high grade non-hodgkin's lymphomas of adults: a need for a new staging system

This study included 120 adult patients of intermediate and grade non- Hodgkin's lymphoma [NLH] in clinical stages II, III and IV. They were treated at Kasr-El-Aini Center of Oncology Nuclear Medicine [NEMROCK] during the period 1984-1987 inclusive. All patients were prospectively treated using 4 different chemotherapy regimens: MEVP [31 patients], COPP/M [23 patients], COPP/A-V [26 patients] and CHOP [40 patients]. The clinical characteristics and prognostic factors in the four groups were comparable. Fifty% [59 patients] of the whole study group attained complete remission [CR]. The highest CR was achieved with CHOP regimen [58%] and the lowest was with MEVP [39%], the difference was statistically insignificant [P > 0.05]. One third of CR relapsed during the follow-up period and two thirds remained disease free for a median of 5 years and a range of 2 to 6 years. Eleven possible risk factors were teated for their correlation with survival. Five factors were tested for their correlation with survival. Five factors were identified to affect survival significantly. When these five factors were subjected to stepwise regression analysis, only the quality of initial response and performance to status sustained their prognostic significance. These factors were used to classify patients into three risk groups [low, intermediate, and high], the 5-year survival were 79%, 36%, 17% respectively. When Ann-Arbor staging system was used, no significant difference in 5 years survival was detected between stages II, III, and IV. The significance of Ann-Arbor staging system as a prognostic indictor is questioned in G2, G3 NHL. A new staging system is proposed