Factors of Prognostic Importance in Childhood Non-Hodgkin's Lymphoma Treated With Two Modified LSA2-L2 Protocols

The results of therapy given to 74 children with advanced disease, abdominal non-Hodgkin's lymphoma were retrospectively evaluated with respect to the major prognostic factors related to disease outcome. The first 36 patients admitted in the study were treated with a modified LSA2-L2 protocol, and the remaining patients received the same regimen with the addition of intermediate-dose methotrexate (MTX) intravenously during the induction phase (LSA2-L2-MTX). The last ten patients admitted were given a leucovorin rescue along with the administration of MTX. The relative efficacy of the LSA2-L2-MTX over the baseline LSA2-L2 regimen was analyzed by multivariate statistical methods taking into consideration several candidate coprognostic factors. The risk of treatment failure was substantially reduced (55%) with the use of the LSA2-L2-MTX regimen. Rescue with leucovorin did not contribute a further significant gain in treatment efficacy, although fewer toxicity-related problems were observed as compared to the no-rescue period. Five prognostic factors emerged as significantly explanatory of the risk of treatment failure in addition to protocol type: lymphocyte count, disease stage, surgical debulking, sex, and nutritional status. Based on these variables, a logistic regression equation could be derived to identify groups that were at risk for treatment failure.

Catching up with history: treatment of Wilms tumor in a developing country

I Despite the tremendous progress that pediatric oncology has achieved in the treatment of Wilms' tumor over the last several decades, survival rates in our institution before 1970 did not exceed 8%. In order to correct the problem standardized therapy was instituted in 1970 through a multimodal oncological team. Results using the new approach were reviewed in 1979 (50 patients) and showed an overall 34% 2-year survival rate. Although encouraging, these results were still far below the ones reported in the literature. This prompted us to use a vigorous professional and lay educational program in the city. Treatment methods were replaced by those advocated by the Second National Wilms' Tumor Study. A second evaluation period initiated in 1979 and extended through 1984 (35 patients) yielded an overall 83% survival rate. A retrospective study of the two periods by univariate and multivariate survival analysis revealed that, although much of the improvement in survival could be attributed to a shift in stage distribution towards earlier disease, the admission period itself had an important additional explanatory effect with respect to survival. This was probably due to the improvement in treatment protocols used in the latter period. Age was a prognostic variable only for patients admitted during the 1979-1984 period