Purpose:
To report the feasibility and results of a study based on the bfm-all. nhl/86 protocol for b-non-hodgin's lymphoma (nhl) and b-acute lymphoblastic leukemia (b-all) in argentina. design. prospective, single arm, non-randomized trial.
Patients and methods:
From august 1988 to december 1993, 87 consecutive patients with b-nhl/b-all were admitted and 82 were eligible. the therapy was stratified according to stage. all patients received a cytoreductive prephase with cyclophosphamide and prednisone. those with stage i-ii were treated with three 5-day blocks of combined intense chemotherapy including dexamethasone, cyclophosphamidie, ifosfamide, cytarabine, teniposide, doxorabicin, and 500 mg/m2 of methotrexate as a 24 hour continuous infusion. stage iii received 6 blocks and those with stage iv/b-all received 6 intensified blocks in which 2 g/m2 of 24 hour continuous infusion methotrexate and vincristine were added. triple intrathecal therapy was given for cns prevention. after the first two blocks the response was assessed and those with a partial response were offered optionallya second look surgery or local radiotherapy.
Results:
With a median follow-up of 38 (range 16-71) months, the event-free survival (pefs) for the whole group was 0.69 (stage i-ii n = 16 pefs = 0.94, stage iii n = 50 pefs = 0.66, stage iv n = 7 pefs = 0.43, b-all n = 9 pefs = 0.66). patients with stage iii abdominal tumors who achieved a partial response by imaging studies after induction had a significantly higher risk of relapse than those with a complete response (p = 0.02). relapse was the most frequent event toxicity was mainly hematological.
Conclusions:
The application of this protocol was feasible in our setting and its results comparable to the german study. patients with stage i-ii had an excellent outcome. those with stage iii and b-all achieved an encouraging event-free survival, however those with abdominal tumors and partial response to induction chemotherapy fared less favourably. this strategy was less effective for patients with initial cns disease.