Comparison of long-term outcome of children and adolescents with disseminated non-lymphoblastic non-hodgkin lymphoma treated with COMP or daunomycin-comp: A report from the children's cancer group

Richard Sposto, Anna T. Meadows, Robert R. Chilcote, Peter G. Steinherz, Carl Kjeldsberg, Marshall E. Kadin, Mark D. Krailo, Amanda M. Termuhlen, Margaret Morse, Stuart E. Siegel

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

Background. Early Children's Cancer Group (CCG) trials indicated that the cyclophosphamide, vincristine, methotrexate, and prednisone (COMP) regimen was superior to the LSA2L2 regimen for non-lymphoblastic (NLB) non-Hodgkin lymphoma (NHL). Studies by other groups suggested that addition of anthracyclines to standard therapies could improve outcome. Therefore, in 1983 CCG initiated study CCG-503, a randomized trial of COMP vs. daunomycin-COMP (D-COMP) in children and adolescents with disseminated NLB NHL. Procedures. Between December 1983 and April 1990, 404 eligible patients were entered. Patients without central nervous system (CNS) or marrow involvement were randomized to receive COMP (N = 139) or D-COMP (N = 145). Randomization was stratified by histology and site of disease. Patients with CNS or marrow involvement (stage IV) were nonrandomly treated with D-COMP (N = 120). Results. Ten-year event-free survival in COMP and D-COMP patients was similar: 55 ± 4.3% (Estimate ± SE) vs. 57 ± 4.2% (not significant). Stage I-III patients with large-cell (LC) NHL had worse 10-year event-free survival (EFS) (48 ± 4.9%) than those with small non-cleaved cell (SNCC) NHL disease (61 ± 3.5%, P < 0.05 in multivariate analysis), but equivalent survival (65 ± 4.7% vs. 63 ± 3.5%) due to significantly higher salvage rates in LC patients, especially those failing more than 12 months from diagnosis. Ten-year EFS in stage IV patients was 39 ± 5.2%. Addition of daunomycin resulted in higher rates of grade 3/4 hematologic toxicity and stomatitis, as well as late cardiac-related deaths. The incidence of second malignant neoplasms was 1.0% at 10 years. Conclusions. Addition of daunomycin to standard COMP therapy did not improve outcome in pediatric disseminated NLB NHL. Patients with LC disease had a significantly reduced long-term EFS, but were retrieved at a higher rate than patients with SNCC disease, resulting in equivalent long-term survival.

Original languageEnglish (US)
Pages (from-to)432-441
Number of pages10
JournalMedical and Pediatric Oncology
Volume37
Issue number5
DOIs
StatePublished - 2001

Keywords

  • Cancer survival
  • Non-Hodgkin lymphoma
  • Pediatric cancers
  • Randomized trials

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