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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

From the Roger Maris Cancer Center, Fargo, ND; University of Southern California School of Medicine, Los Angeles, and Children’s Cancer Group, Arcadia, CA; Geisinger Medical Center, Danville, and Children’s Hospital, Philadelphia, PA; University of Nebraska Medical Center, Omaha, NE; Children’s Hospital Medical Center, Cincinnati, and University Hospitals, Cleveland, OH; Children’s Hospital, Denver, CO; Mayo Clinic, Rochester, MN; and Riley Hospital for Children, Indianapolis, IN.

Address reprint requests to Nathan L. Kobrinsky, MD, Children’s Cancer Group, PO Box 60012, Arcadia, CA 91066-6012.

PURPOSE: To determine the toxicity and response rate in children treated with dexamethasone, etoposide, cisplatin, high-dose cytarabine, and L-asparaginase (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.

Contributing Children’s Cancer Group investigators, institutions, and grant numbers are given in the Appendix.

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