Outcomes of treatment of children and adolescents with recurrent non-Hodgkin's lymphoma and Hodgkin's disease with dexamethasone, etoposide, cisplatin, cytarabine, and L-asparaginase, maintenance chemotherapy, and transplantation: Children's cancer group study CCG-5912

N. L. Kobrinsky, R. Sposto, N. R. Shah, J. R. Anderson, C. DeLaat, M. Morse, P. Warkentin, G. S. Gilchrist, M. D. Cohen, D. Shina, A. T. Meadows

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

Purpose: To determine the toxicity and response rate in children treated with dexamethasone, etoposide, cisplatin, high-dose cytarabine, and L-asparagi-nase (DECAL) for recurrent non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). Patients and Methods: Ninety-seven children with recurrent NHL (n = 68) or HD (n = 29) were enrolled. Treatment consisted of two cycles of DECAL, then bone marrow transplantation or up to four cycles of ifosfamide, mesna, and etoposide alternating with DECAL maintenance therapy. Results: After two cycles of DECAL induction therapy, complete response (CR) or partial response (PR) was reported in 19 (65.5%; 10 CRs and nine PRs) of 29 patients with HD and 29 (41.6%; 23 CRs and six PRs) of 68 patients with NHL. When only 24 patients with HD and 58 patients with NHL who were assessable for response were considered, the response rates were 79.2% (19 of 24 patients) and 50.0% (29 of 58 patients), respectively. Five-year event-free survival was 26% ± 9% and 23% ± 5% in patients with HD and NHL, respectively. Five-year survival was 31% ± 14% and 30% ± 6%, respectively. Although median time to treatment failure was significantly longer in patients with HD (EFS, P = .002; survival, P = .011), this difference did not translate into a higher long-term survival. Grade 3 or 4 toxic effects were observed during induction in 70 (72%) of 97 patients and during maintenance in 45 (70%) of 64 courses of DECAL therapy. Pancytopenia and systemic infections in particular were frequently observed. Other toxic effects were uncommon. Although not a formal part of the therapy or the study design, 42 patients who responded to therapy who underwent bone marrow transplant did not show any benefit from this approach. Conclusion: DECAL is an effective and tolerable salvage regimen for treating patients with recurrent NHL and HD.

Original languageEnglish (US)
Pages (from-to)2390-2396
Number of pages7
JournalJournal of Clinical Oncology
Volume19
Issue number9
DOIs
StatePublished - May 1 2001

Fingerprint

Maintenance Chemotherapy
Asparaginase
Cytarabine
Etoposide
Hodgkin Disease
Non-Hodgkin's Lymphoma
Dexamethasone
Cisplatin
Transplantation
Neoplasms
Poisons
Survival
Therapeutics
Mesna
Ifosfamide
Pancytopenia
Treatment Failure
Bone Marrow Transplantation
Disease-Free Survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Outcomes of treatment of children and adolescents with recurrent non-Hodgkin's lymphoma and Hodgkin's disease with dexamethasone, etoposide, cisplatin, cytarabine, and L-asparaginase, maintenance chemotherapy, and transplantation : Children's cancer group study CCG-5912. / Kobrinsky, N. L.; Sposto, R.; Shah, N. R.; Anderson, J. R.; DeLaat, C.; Morse, M.; Warkentin, P.; Gilchrist, G. S.; Cohen, M. D.; Shina, D.; Meadows, A. T.

In: Journal of Clinical Oncology, Vol. 19, No. 9, 01.05.2001, p. 2390-2396.

Research output: Contribution to journalArticle

@article{40a1a47ee4f74ebf9f63b3a5c20fb3cf,
title = "Outcomes of treatment of children and adolescents with recurrent non-Hodgkin's lymphoma and Hodgkin's disease with dexamethasone, etoposide, cisplatin, cytarabine, and L-asparaginase, maintenance chemotherapy, and transplantation: Children's cancer group study CCG-5912",
abstract = "Purpose: To determine the toxicity and response rate in children treated with dexamethasone, etoposide, cisplatin, high-dose cytarabine, and L-asparagi-nase (DECAL) for recurrent non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). Patients and Methods: Ninety-seven children with recurrent NHL (n = 68) or HD (n = 29) were enrolled. Treatment consisted of two cycles of DECAL, then bone marrow transplantation or up to four cycles of ifosfamide, mesna, and etoposide alternating with DECAL maintenance therapy. Results: After two cycles of DECAL induction therapy, complete response (CR) or partial response (PR) was reported in 19 (65.5{\%}; 10 CRs and nine PRs) of 29 patients with HD and 29 (41.6{\%}; 23 CRs and six PRs) of 68 patients with NHL. When only 24 patients with HD and 58 patients with NHL who were assessable for response were considered, the response rates were 79.2{\%} (19 of 24 patients) and 50.0{\%} (29 of 58 patients), respectively. Five-year event-free survival was 26{\%} ± 9{\%} and 23{\%} ± 5{\%} in patients with HD and NHL, respectively. Five-year survival was 31{\%} ± 14{\%} and 30{\%} ± 6{\%}, respectively. Although median time to treatment failure was significantly longer in patients with HD (EFS, P = .002; survival, P = .011), this difference did not translate into a higher long-term survival. Grade 3 or 4 toxic effects were observed during induction in 70 (72{\%}) of 97 patients and during maintenance in 45 (70{\%}) of 64 courses of DECAL therapy. Pancytopenia and systemic infections in particular were frequently observed. Other toxic effects were uncommon. Although not a formal part of the therapy or the study design, 42 patients who responded to therapy who underwent bone marrow transplant did not show any benefit from this approach. Conclusion: DECAL is an effective and tolerable salvage regimen for treating patients with recurrent NHL and HD.",
author = "Kobrinsky, {N. L.} and R. Sposto and Shah, {N. R.} and Anderson, {J. R.} and C. DeLaat and M. Morse and P. Warkentin and Gilchrist, {G. S.} and Cohen, {M. D.} and D. Shina and Meadows, {A. T.}",
year = "2001",
month = "5",
day = "1",
doi = "10.1200/JCO.2001.19.9.2390",
language = "English (US)",
volume = "19",
pages = "2390--2396",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "9",

}

TY - JOUR

T1 - Outcomes of treatment of children and adolescents with recurrent non-Hodgkin's lymphoma and Hodgkin's disease with dexamethasone, etoposide, cisplatin, cytarabine, and L-asparaginase, maintenance chemotherapy, and transplantation

T2 - Children's cancer group study CCG-5912

AU - Kobrinsky, N. L.

AU - Sposto, R.

AU - Shah, N. R.

AU - Anderson, J. R.

AU - DeLaat, C.

AU - Morse, M.

AU - Warkentin, P.

AU - Gilchrist, G. S.

AU - Cohen, M. D.

AU - Shina, D.

AU - Meadows, A. T.

PY - 2001/5/1

Y1 - 2001/5/1

N2 - Purpose: To determine the toxicity and response rate in children treated with dexamethasone, etoposide, cisplatin, high-dose cytarabine, and L-asparagi-nase (DECAL) for recurrent non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). Patients and Methods: Ninety-seven children with recurrent NHL (n = 68) or HD (n = 29) were enrolled. Treatment consisted of two cycles of DECAL, then bone marrow transplantation or up to four cycles of ifosfamide, mesna, and etoposide alternating with DECAL maintenance therapy. Results: After two cycles of DECAL induction therapy, complete response (CR) or partial response (PR) was reported in 19 (65.5%; 10 CRs and nine PRs) of 29 patients with HD and 29 (41.6%; 23 CRs and six PRs) of 68 patients with NHL. When only 24 patients with HD and 58 patients with NHL who were assessable for response were considered, the response rates were 79.2% (19 of 24 patients) and 50.0% (29 of 58 patients), respectively. Five-year event-free survival was 26% ± 9% and 23% ± 5% in patients with HD and NHL, respectively. Five-year survival was 31% ± 14% and 30% ± 6%, respectively. Although median time to treatment failure was significantly longer in patients with HD (EFS, P = .002; survival, P = .011), this difference did not translate into a higher long-term survival. Grade 3 or 4 toxic effects were observed during induction in 70 (72%) of 97 patients and during maintenance in 45 (70%) of 64 courses of DECAL therapy. Pancytopenia and systemic infections in particular were frequently observed. Other toxic effects were uncommon. Although not a formal part of the therapy or the study design, 42 patients who responded to therapy who underwent bone marrow transplant did not show any benefit from this approach. Conclusion: DECAL is an effective and tolerable salvage regimen for treating patients with recurrent NHL and HD.

AB - Purpose: To determine the toxicity and response rate in children treated with dexamethasone, etoposide, cisplatin, high-dose cytarabine, and L-asparagi-nase (DECAL) for recurrent non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). Patients and Methods: Ninety-seven children with recurrent NHL (n = 68) or HD (n = 29) were enrolled. Treatment consisted of two cycles of DECAL, then bone marrow transplantation or up to four cycles of ifosfamide, mesna, and etoposide alternating with DECAL maintenance therapy. Results: After two cycles of DECAL induction therapy, complete response (CR) or partial response (PR) was reported in 19 (65.5%; 10 CRs and nine PRs) of 29 patients with HD and 29 (41.6%; 23 CRs and six PRs) of 68 patients with NHL. When only 24 patients with HD and 58 patients with NHL who were assessable for response were considered, the response rates were 79.2% (19 of 24 patients) and 50.0% (29 of 58 patients), respectively. Five-year event-free survival was 26% ± 9% and 23% ± 5% in patients with HD and NHL, respectively. Five-year survival was 31% ± 14% and 30% ± 6%, respectively. Although median time to treatment failure was significantly longer in patients with HD (EFS, P = .002; survival, P = .011), this difference did not translate into a higher long-term survival. Grade 3 or 4 toxic effects were observed during induction in 70 (72%) of 97 patients and during maintenance in 45 (70%) of 64 courses of DECAL therapy. Pancytopenia and systemic infections in particular were frequently observed. Other toxic effects were uncommon. Although not a formal part of the therapy or the study design, 42 patients who responded to therapy who underwent bone marrow transplant did not show any benefit from this approach. Conclusion: DECAL is an effective and tolerable salvage regimen for treating patients with recurrent NHL and HD.

UR - http://www.scopus.com/inward/record.url?scp=0035340511&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035340511&partnerID=8YFLogxK

U2 - 10.1200/JCO.2001.19.9.2390

DO - 10.1200/JCO.2001.19.9.2390

M3 - Article

C2 - 11331317

AN - SCOPUS:0035340511

VL - 19

SP - 2390

EP - 2396

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 9

ER -