剂量调整 B-NHL-BFM95方案治疗儿童非霍奇金淋巴瘤临床研究

目的：探讨改良 B-NHL-BFM95方案治疗儿童非霍奇金淋巴瘤的临床疗效和毒副反应。方法入组20例经病理确诊的14岁以下非霍奇金淋巴瘤患者,均接受改良 B-NHL-BFM95方案治疗,未行放疗。结果近期疗效：18例（900%）CR,2例（100%）PD。治疗期间大部分患者出现Ⅲ、Ⅳ度骨髓抑制,经对症处理恢复正常,不影响下一步治疗。中位随访55个月,全组3 a 无事件生存率800%,Ⅰ~Ⅱ期1000%,Ⅲ~Ⅳ期600%;低危组1000%,中危组857%,高危组500%。结论改良 B-NHL-BFM-95方案治疗儿童非霍奇金淋巴瘤,特别是低、中危儿童非霍奇金淋巴瘤疗效显著,毒副反应可耐受。     

改良B-NHL-BFM-90方案治疗儿童青少年间变T细胞淋巴瘤的疗效分析

背景与目的：儿童青少年间变大细胞淋巴瘤侵袭性较强,最佳的治疗策略和方案仍需要探讨。本研究总结采用改良B-NHL-BFM-90方案治疗的儿童青少年间变T细胞淋巴瘤疗效和生存率,探讨该治疗方案的临床推广价值。方法：从2002年10月至2008年1月,18例16岁以下经病理确诊的初治间变T细胞淋巴瘤患者入组,采用改良B—NHL-BFM-90方案治疗,药物包括cyclophosphamide、vincristine、ifosfamide、etoposide、adriamycin、HD—methotrexate、vindesine、dexamethasone、cytarabine或HD—cytarabine,同时每个疗程鞘内注射一次。结果：15例（83．3％）完全缓解（complete remission,cR）,3例（16．7％）部分缓解（partialre mission,PR）,总有效率100％。中位随访31个月（4～68个月）,全组3年无事件生存率（event—freesurvival,EFS） （87．4±8．4）％;Ⅰ／Ⅱ期患者为100％,Ⅲ／Ⅳ期患者为（85．1±9．7）％;低危组100％,中危组（88．9±10．5）％,高危组（80．O±17．9）％。治疗期间大部分患者发生Ⅲ／Ⅳ度骨髓抑制,积极对症支持治疗后均恢复。1例Ⅳ期患者CR后行自体造血干细胞移植生存至今。2例患者分别于停止治疗3个月和5个月后复发死亡。结论：改良B—NHL—BFM-90方案是治疗儿童青少年间变T细胞淋巴瘤的有效方案．其毒性患者可耐受,但需要在有经验的肿瘤中心和血液科中应用。     

13例伯基特和伯基特样淋巴瘤的临床特点分析

目的：分析伯基特淋巴瘤（BL）和伯基特样淋巴瘤（BLL）的临床特点,总结疗效,探讨可能的最佳方案和治疗相关合并症。方法：回顾性分析北京肿瘤医院1996年8 月至2008年10月收治的13例经病理确诊为伯基特淋巴瘤和伯基特样淋巴瘤患者的临床资料。所有患者均接受化疗为主的治疗方案,评价疗效和不良反应。结果：13例患者中,男12例,女1 例;发病年龄11～62岁,中位年龄15岁;Ⅰ期3 例,Ⅱ期2 例,Ⅲ期2 例,Ⅳ期6 例,其中晚期（Ⅲ、Ⅳ期）病例占61.5% ,初治时发生骨髓侵犯2 例（15.4%）,中枢神经系统侵犯4 例（30.8%）;常见的侵犯部位为浅表淋巴结（61.5%）、腹腔脏器（53.8%）和腹腔及腹膜后淋巴结（38.5%）;有B 症状7 例（53.8%）;8/10例（80.0%）血清乳酸脱氢酶（LDH ）水平升高,1/10例血清尿酸升高;病理示BL11例,BLL 2 例。11例患者获得完全缓解或未经证实的完全缓解,1 例部分缓解,总有效率为92.3% 。中位随访时间8 个月（5～35个月）,至随访截止6 例患者死亡,1 例失访。1 年总生存率（OS）、无进展生存率（PFS）和无瘤生存率（DFS）分别为 56.98%、32.31%和39.77%。化疗中Ⅲ～Ⅳ度骨髓抑制发生率为69.2% ,1 例患者出现肿瘤溶解综合征和Ⅳ度全消化道黏膜炎。结论：推荐高强度短疗程化疗方案作为BL和BLL 的一线治疗,应积极预防处理化疗不良反应。     

改良R/ACVBP方案治疗年轻高危侵袭性淋巴瘤的初步研究

目的 探讨改良R/ACVBP方案治疗年轻高危侵袭性淋巴瘤的疗效及耐受性.方法 入组采用改良R/ACVBP方案治疗的年轻高危侵袭性淋巴瘤患者21例,其中4例合并使用美罗华.结果 21例患者中,17例CR,3例PR,1例PD,总有效率95.2％ (20/21),CR率81.0％(17/21),截至随访日期,已死亡6例,5例死于本病,1例死于肝功能衰竭;中位随访42个月,3 a总生存率71.4％.13例出现Ⅲ、Ⅳ度粒细胞减少;3例出现Ⅲ、Ⅳ度血红蛋白减少;1例出现Ⅲ度血小板减少;5例合并感染,其中3例为间质性肺炎并感染;7例出现Ⅲ、Ⅳ度肝功能异常,其中6例为转氨酶升高,1例胆红素、转氨酶同时升高.结论 改良R/ACVBP方案治疗年轻高危侵袭性淋巴瘤疗效好,但骨髓抑制及继发感染明显,继续应用该方案须谨慎.     

局部晚期鼻咽癌患者放化综合治疗临床观察

目的:探讨Ⅲ、ⅣA期鼻咽癌患者放化综合治疗的疗效和影响预后因素.方法:选取符合入组条件的Ⅲ、ⅣA期初治鼻咽癌患者156例,分为单纯放疗组(78例)和放化综合治疗组(78例).用Kaplan-Meier方法计算生存率,用Cox比例风险模型分析预后影响因素.结果:单纯放疗组的3年总生存率为42.8%(33/78),放化疗综合治疗组为75.9%(59/78),两组比较差异有统计学意义,P＝0.007.临床分期、N分期、是否化疗、治疗后是否残留是影响鼻咽癌患者生存的相关因素.结论:放化综合治疗对Ⅲ、ⅣA期鼻咽癌效果较好.     

子宫内膜腺癌306例

目的 比较不同治疗方法治疗子宫内膜癌的疗效.方法 1989年6月至2007年5月收治306例子宫内膜腺癌患者,单纯手术145例,手术+放射治疗161例.治疗后随坊均在5年以上,观察各组的5年生存率.结果 手术病理分期Ⅰ期、Ⅱ期及Ⅲ～Ⅳ期的5年生存率分别为78.9%(56/71)、61.0%(25/41)及18.2%(6/33);手术+放疗组分别为75.0%(33/44)、59.5%(44/74)及48.8%(21/43).两组Ⅰ期及Ⅱ期患者的5年生存率差异无统计学意义(P>0.05),而Ⅲ～Ⅳ期5年生存率手术+放疗患者明显高于手术组(P<0.001).结论 Ⅰ、Ⅱ期子宫内膜腺癌单纯手术治疗可达到预期效果,Ⅲ、Ⅳ期子宫内膜腺癌患者术后要加放疗,对有高危因素的子宫内膜腺癌,即使是临床早期术后也要辅助放疗.     

美罗华联合Hyper-CVAD/MTX+Ara-C方案治疗高危青年伯基特淋巴瘤的疗效观察（附6例）

目的:分析美罗华联合Hyper-CVAD/MTX+Ara-C方案治疗高危青年伯基特淋巴瘤的治疗效果。方法:总结2014年10月至2016年10月,我院收治的6例伯基特淋巴瘤患者的特征，均采用美罗华联合Hyper-CVAD/MTX+Ara-C方案化疗，历时4个周期共8个疗程，病程中腰穿及鞘注。结果:6例初诊患者临床分期(Arbor分期)Ⅲ期1例，Ⅳ期5例；首发部位多见于腹部包块及浅表淋巴结，均有B症状，乳酸脱氢酶（LDH）水平偏高，骨髓侵犯3例，中枢神经系统侵犯1例，有结外侵犯者3例。总疗程结束后评估，CR 5例，PR 1例，平均缓解期2.3个月。随访2.5年，5例患者病情稳定，1例死亡。结论:美罗华联合Hyper-CVAD/MTX+Ara-C方案治疗高危青年伯基特淋巴瘤有一定效果，患者对联合化疗的耐受性尚可。     

西南地区鼻和鼻型NK/T细胞淋巴瘤的临床病理特征及预后分析

目的分析西南地区鼻和鼻型NK/T细胞淋巴瘤的临床病理特征及影响预后的因素.方法分析120例鼻和鼻型NK/T细胞淋巴瘤的病理形态及免疫表型、临床特点、治疗和生存情况.结果120例患者总的5年生存率为54.1%.大型瘤细胞生存率较中小型瘤细胞低(P＜0.01),病变中有坏死及血管浸润者生存率明显低于对照组(P＜0.05),而瘤细胞分布及患病年龄与预后关系不大,临床Ⅰ～Ⅱ期与Ⅲ～Ⅳ期两组病例生存率差异有显著性(P＜0.01),累及多个部位、伴有穿孔及全身症状者生存率低于对照组(P＜0.05).综合治疗疗效优于单一治疗及未治疗组(P＜0.01),单一治疗近期疗效好,而远期疗效与未治疗组差异无显著性(P＞0.05).Cox Regression分析结果亦表明瘤细胞大小、分期及治疗方法与预后密切相关.结论瘤细胞大小、坏死、血管浸润、穿孔、B症状、分期、病变范围和治疗方法与鼻和鼻型NK/T细胞淋巴瘤的预后相关,其中瘤细胞大小、分期和治疗方法是其主要的预后因素.     

R-CHOP方案治疗Ⅲ～Ⅳ期老年DLBCL的临床疗效及耐受性分析

目的 探讨R-CHOP方案(利妥昔单抗、环磷酰胺、表柔比星、长春新碱、泼尼松龙)在Ⅲ～Ⅳ期≥60岁老年弥漫大B细胞淋巴瘤中的疗效及安全性.方法 收集≥60岁的Ⅲ～Ⅳ期弥漫大B细胞淋巴瘤患者33例,行R-CHOP 3周方案化疗6疗程,观察治疗反应率、生存率以及相关不良反应.结果 全组33例患者中,25例(75.8％)完成6疗程化疗,完全缓解(complete remission,CR)及不确定完全缓解(unconfirmed complete remission,uCR) 12例(36.4％).总有效率(完全缓解或部分缓解)为81.8％ (27/33).全组中位随访时间为25.2月(2.0-77.6月),2年总生存率为51.2％,2年无进展生存率为39.4％,2年无事件生存率为38.6％.截至随访结束,15例生存,12例(36.4％)为无瘤生存.治疗过程中2例(6.1％)因治疗相关感染死亡,＞ 1/3的患者曾出现Ⅲ～Ⅳ级的骨髓抑制.单因素及多因素分析发现,近期疗效为CR的患者预后明显好于其他患者.结论 足量的R-CHOP化疗在≥60岁老年Ⅲ～Ⅳ期弥漫大B细胞淋巴瘤患者中有较好的耐受性、安全性和有效率.但疗效持续时间短,其长期疗效仍不理想.     

改良BFM-90方案治疗20例儿童青少年淋巴母细胞型淋巴瘤

背景与目的：儿童青少年淋巴母细胞型淋巴瘤属于高度恶性淋巴瘤．进展快,死亡牢高。德国BFM-90淋巴母方案是目前治疗儿童青少年淋巴母细胞型淋巴瘤疗效最好的方案之一。本研究采用改良BFM-90淋巴母方案治疗中国儿童青少年淋巴母细胞型淋巴瘤,观察其疗效、毒性和可行性。方法：20例3～18岁初治的T淋巴母细胞淋巴瘤患者,Ⅲ期7例,Ⅳ期13例。18例(90％)患者有纵隔肿块伴上腔静脉阻塞综合征,10例(50％)有骨髓侵犯。所有患者均接受改良BFM-90方案化疗．方案包括诱导缓解、巩固治疗和中枢神经系统预防、再诱导缓解和维持治疗。总疗程2年。用Kaplan-Meier法统计全组生存率。结果：诱导缓解结束后18例(90％)患者获得完全缓解(complete response,CR),1例(5％)部分缓解(partial response,PR),1例(5％)肿瘤进展(progressive disease,PD),总有效率95％。PR和PD的2例患者最后肿瘤进展死亡。CR的18例患者中有2例在再诱导结束后CR1时行外周血自体造血干细胞移植。移植后有1例复发,经再次化疗后CR存活;另1例一直存活。其他CR的患者中有5例复发,其中1例行异基因移植后存活,1例自体造血干细胞移植后存活,3例复发后单纯化疗的患者肿瘤进展死亡。全组患者3年总生存率74％。所有患者在诱导和再诱导阶段均发生Ⅲ／Ⅳ骨髓抑制,积极对症处理后可恢复。结论：改良德国BFM-90淋巴母方案适用于中国儿童青少年淋巴母细胞型淋巴瘤患者,可明显改善生存率;主要不良反应是血液毒性,应在有经验的血液／肿瘤中心中应用。     

改良BFM-90方案明显改善儿童青少年淋巴母细胞型淋巴瘤的疗效

目的探讨改良BFM-90方案治疗儿童青少年淋巴母细胞型淋巴瘤的疗效,分析其不良反应和生存率。方法收集36例3～18岁初治的淋巴母细胞型淋巴瘤患者入组,Ⅱ期1例,Ⅲ期9例,Ⅳ期26例。28例(77.7%)为T细胞表型,26例(72.2%)患者有纵隔肿块,21例(58.3%)有骨髓侵犯。全部患者采用改良的BFM-90方案化疗,其方案包括诱导缓解、中枢神经系统预防、再诱导缓解和维持治疗,总疗程2年。此方案与标准的BFM-90方案不同之处是不做头颅预防照射,但维持治疗期间定期大剂量甲氨蝶呤(HD-MTX)静脉输注和鞘内注射。结果32例(88。8%)患者获得完全缓解(CR),1例(2.7%)部分缓解(PR),总有效率90.7%。1例进展(PD)。2例患者在第1次完全缓解后(CR1)行自体造血干细胞移植(APBSCT),2例患者行纵隔放疗。复发5例,其中2例挽救治疗后存活,另3例肿瘤进展死亡;诱导期死亡2例,1例死于真菌败血症,另1例死于脑出血。PR和PD2例患者均死于肿瘤进展;共7例患者死亡。中位随访时间28个月,3年总生存率为78.3%。主要的毒性反应是骨髓抑制、感染和出血等,需要积极处理。结论改良BFM-90方案可明显改善儿童青少年淋巴母细胞型淋巴瘤的疗效和生存率,主要不良反应为骨髓抑制,应在有经验的肿瘤中心或血液科中应用。     

BFM-90、CHOP和 CHOP/HD-MTX方案治疗儿童青少年 B细胞非霍奇金淋巴瘤的生存率比较

背景与目的：儿童青少年B细胞非霍奇金淋巴瘤(B cell non-Hodgkin’s lymphoma,B-NHL)恶性程度高、进展快、早期患者对常规CHOP方案化疗可获得较好疗效,但晚期患者疗效差。对不同分期的患者应如何治疗值得进一步探索。本文回顾性分析和比较CHOP、CHOP HD-MTX和德国BFM-90方案治疗儿童青少年B-NHL的疗效、不良反应和生存率。方法：CHOP方案组30例3～17岁初治的B-NHL患者,Ⅰ／Ⅱ期13例,Ⅲ／Ⅳ期(St Jude分期)17例,均接受2～8疗程常规CHOP方案化疗,每3周重复。CHOP HD-MTX组18例3～14岁初治的B-NHL患者,Ⅰ／Ⅱ期6例,Ⅲ／Ⅳ期(st Jude分期)12例,均接受2～8疗程CHOP HD-MTX方案化疗和鞘注,每4周重复。BFM-90方案组25例1．5～15岁的初治的B-NHL患者,Ⅱ期7例,Ⅲ／Ⅳ期(St Jude分期)18例,均接受NHL-BFM-90方案化疗。Ⅰ／Ⅱ期患者接受A和B疗程交替化疗共4～6疗程;Ⅲ／Ⅳ期患者接受AA和BB疗程交替化疗共6疗程,每疗程间隔18～21天。结果：CHOP组21例(70％)完全缓解(complete response,CR),4例(13％)部分缓解(partial response,PR);有20％的疗程发生Ⅲ／Ⅳ级血液毒性。CHOP HD-MTX组15例(83％)CR,3例(16％)PR;有52％疗程发生Ⅲ／Ⅳ级血液毒性。BFM-90方案组24例(96％)CR,1例(4％)PR;Ⅲ／Ⅳ级血液毒性：A疗程57％,B疗程60％,AA疗程91％,BB疗程76％;AA疗程的血液毒性明显高于其他疗程。Ⅱ／Ⅲ级粘膜炎主要发生在AA和BB疗程,占35％。三组均按Kaplan-Meier方法进行生存率统计。CHOP组2年总生存率52．79％,Ⅰ／Ⅱ期患者72．73％,Ⅲ／Ⅳ期37．82％。CHOP HD-MTX组2年总生存率55．56％,Ⅰ／Ⅱ期患者83．33％,Ⅲ／Ⅳ期41．67％。CHOP组患者生存率与CHOP HD-MTX组比较无显著性差异(P=0．78)。BFM-90方案组2年无事件生存率84．01％,Ⅰ／Ⅱ期患者100．00％,Ⅲ／Ⅳ期患者77．04％。BFM-90方案组生存率与CHOP组和CHOP HD-MTX组比较有显著性差异(P=0．013,0．034)。结论：BFM-90方案能明显提高儿童青少年B-NHL的生存率,特别是对晚期患者的疗效改善更明显。CHOP和CHOP HD-MTX对早期患者可获得较好的疗效,但对晚期患者疗效差。对晚期B-NHL应采用类似BFM-90方案的高强度化疗。     

Short-term weekly chemotherapy followed by high-dose therapy with autologous bone marrow transplantation for lymphoblastic and Burkitt's lymphomas in adult patients

Background: Type and duration of treatment for highly aggressivenon-Hodgkin's lymphoma has been a matter of debate over thepast decade. To determine the therapeutic efficacy of an abbreviatedtreatment regimen, 26 patients with newly-diagnosed highly aggressivelymphomas, 17 of them belonging to the International WorkingFormulation (IWF) group I and 9 with Burkitt's lymphoma (IWFJ), were entered in a study using short-term weekly chemotherapyfollowed by high-dose therapy and autologous bone marrow transplantation.Patients and methods: Besides histology, requirements for entryinto to the study were age between 16 and 60 years, stage Ibulky disease and elevated LDH or stage II to IV disease withor without bulk or elevated LDH, and an absence of HTV infectionor CNS involvement at diagnosis. The treatment plan was 12 weeksof MACOP-B or VACOP-B chemotherapy followed by high dose therapyand autologous bone marrow transplantation in first completeremission. Results: Twenty patients (76%), 16 (62%) of thoseon MACOP-B or VACOP-B, 1 who had received 2 cycles of ProMACE-CytaBOMprior to MACOP-B and 3 after a first salvage reigmen, achievedcomplete remissions. Seventeen patients (65%) were transplantedin first remission, and 15 (58%) after induction treatment withonly MACOP-B or VACOP-B. Reasons for not being given high dosetherapy and autologous bone marrow transplantation (ABMT) werefailure to achieve complete remission in 6 patients, early relapsein 2 and severe pulmonary toxicity associated with chemotherapyin 1. The median time of follow-up was 45 months. At 3 years,the estimated event-free survival was 31% (CI 14%–50%)and the overall survival 48% (CI 25%–67%). There wereno deaths from toxic effects of treatment. Pretreatment factorsassociated with relapse were stage III or IV disease, age over30 years and bone marrow involvement. Logrank analysis showedthat age was the only factor significantly associated with poorevent-free survival. Conclusion: Short-term weekly chemotherapyfollowed by high-dose therapy with the CBV regimen in firstremission is not a highly effective treatment for advanced lymphoblasticand Burkitt's lymphomas. The 30% rate of failure to achievepartial remission after 6 weeks and/or complete response after12 weeks of MACOP-B or VACOP-B treatment, as well as the 42%failure rate to undergo ABMT in first remission, suggest thatmore aggressive chemotherapy should be used in the beginning. lymphoblastic lymphoma, Burkitt's lymphoma, VACOP-B, MACOP-B, ABMT, first remission     

Germinal-center type B-cell classification and clinical characteristics of Chinese pediatric diffuse large B-cell lymphoma:a report of 76 cases

Pediatric diffuse large B-cell lymphoma （DLBCL） is a highly aggressive disease with unique clinical characteristics. This study analyzed the germinal-center type B-cell （GCB） classification and clinical characteristics of Chinese pediatric DLBCL. A total of 76 patients with DLBCL newly diagnosed in Sun Yat- sen University Cancer Center between February 2000 and May 2011, with an age younger than 18 years, were included in the analysis. The male/female ratio was 3.47：1. The median age was 12 years （range, 2 to 18 years）, and 47 （61.8%） patients were at least 10 years old. Of the 76 patients, 48 （63.2%） had stage Ill/IV disease, 9 （11.8%） had bone marrow involvement, 1 （1.3%） had central nervous system （CNS） involvement, and 5 （6.6%） had bone involvement. The GCB classification was assessed in 45 patients： 26 （57.8%） were classified as GCB subtype, and 19 （42.2%） were classified as non-GCB subtype. The modified B-NHL-BFM-90/95 regimen was administered to 50 patients, and the 4-year event-free survival （EFS） rate was 85.8%. Among these 50 patients, 31 were assessed for the GCB classification： 17 （54.8%） were classified as GCB subtype, with a 4-year EFS rate of 88.2%; 14 （45.2%） were classified as non-GCB subtype, with a 4-year EFS rate of 92.9%. Our data indicate that bone marrow involvement and stage III/ IV disease are common in Chinese pediatric DLBCL patients, whereas the percentage of patients with the GCB subtype is similar to that of patients with the non-GCB subtype. The modified B-NHL-BFM-90/95 protocol is an active and effective treatment protocol for Chinese pediatric patients with DLBCL.     

Intensive chemotherapy improved treatment outcome for Chinese children and adolescents with lymphoblastic lymphoma

Background  Lymphoblastic lymphoma (LBL) is a highly aggressive lymphoma, for which intensive chemotherapy is necessary. This study was designed to evaluate the efficacy and toxicity of a modified acute lymphoblastic leukemia (ALL)-Berlin-Frankfurt-Münster (BFM)-90-based protocol in Chinese children and adolescents with LBL. Methods  From March 1998 to November 2006, 60 untreated patients with LBL (age <18 years) from a single institution were enrolled. All patients were treated with the modified ALL-BFM-90 protocol, and prophylactic cranial radiotherapy was omitted. Results  The median age of the patients was 10 years (range, 2.5–18 years). Forty-eight (80%) patients had T-cell LBL, and 59 (98.3%) of the patients were stage III/IV. At the end of induction remission Ia (day 33), 3 patients had died of treatment-related toxicity. In the remaining 57 patients, complete remission (CR) or CR undetermined (CRu) had occurred in 47 (82.45%), who were designated as the moderate-risk group and partial remission (PR) had occurred in 10 patients (17.54%), who were designated the high-risk group. All patients experienced grade 3–4 hematological toxicity. At a median follow-up of 35 months, event-free survival was 78.81% ± 0.05 for all patients; the figure was 88.34% ± 0.05 for the moderate-risk group (90.91% ± 0.08 for stage III, 87.68% ± 0.06 for stage IV, 100% for those with B-cell LBL, 84.78% ± 0.06 for those with T-cell LBL, and 82.94% ± 0.08 for stage IV patients with more than 25% blast cells in bone marrow [BM]). The event-free survival in the high-risk group was 60% ± 0.15. Conclusion  This modified ALL-BFM-90 protocol is an effective regimen and it greatly improved the survival rate of Chinese children and adolescents with LBL compared with the ALL protocols used previously.     

HiC-COM: a 2-month intensive chemotherapy regimen for children with stage III and IV Burkitt's lymphoma and B-cell acute lymphoblastic leukemia

We designed a protocol that included 2 months of intensive Cytoxan (cyclophosphamide; Bristol-Myers Co, Evansville, IN), high-dose methotrexate (MTX), high-dose cytarabine (ara-C), and vincristine (HiC-COM) to improve event-free survival (EFS) for patients with advanced-stage Burkitt's lymphoma and B-cell acute lymphoblastic leukemia (ALL). We also wished to test the feasibility of rapidly cycling Cytoxan and high-dose ara-C based on signs of early marrow recovery. Twenty patients including 12 with stage III Burkitt's lymphoma and eight with stage IV Burkitt's lymphoma or B-cell ALL were entered onto this pilot study. The rate of complete remission was 95%. Four patients have relapsed. The 2-year actuarial EFS was 75% (median follow-up, 37 months). Two of the initial five patients developed transverse myelitis, which we believe may have been secondary to the concomitant administration of intrathecal (IT) and high-dose systemic ara-C. We conclude that this short but intensive regimen is highly effective for patients with advanced Burkitt's lymphoma and B-cell ALL. EFS has improved over previous less intensive regimens, and is comparable to regimens of longer duration.     

Therapeutic results in 22 cases of childhood non-Hodgkin's lymphoma treated by ACOP combination chemotherapy

Twenty-two cases of childhood non-Hodgkin's lymphoma were treated during the past 8 years from 1979 to 1986. Median age was 7 years 4 months and the age range was from 2 years 4 months to 14 years 9 months, the male to female ratio being 18 : 4. Primary sites were common in the mediastinum (n = 7) and abdomen (n = 6) followed by submandibular lymph nodes (n = 3). According to Murphy's staging system, 7 were in stage I/II and 15 in stage III/IV. Histological studies of lymphoma tissues and blasts in the cerebrospinal fluid, pleural effusion or ascites revealed that 9 cases were lymphoblastic lymphoma while only 3 were defined as Burkitt's lymphoma. With our protocol of systemic combination chemotherapy (i.e. ACOP), intrathecal methotrexate and/or involved field irradiation, twenty-one out of the 22 cases (93%) attained complete remission and 14 patients are currently alive in continuous complete remission, with a median survival of 28+ months (range 6+ approximately 76+ months).