A pilot study for the treatment of non-Hodgkin's lymphoma in children with acquired immunodeficiency syndromes
Purpose. Obtain preliminary response, toxicity, and survival data in patients with non-Hodgkin's lymphomas (NHLs) and immunodeficiency syndromes using short-duration chemotherapy, granulocyte colony-stimulating factor (G-CSF), intravenous (IV) immunoglobulin, and for HIV-infected patients, antiretroviral therapy. Methods. The primary chemotherapy regimen consisted of three cycles of IV cyclophosphamide and methotrexate, and intrathecal (IT) cytarabine and methotrexate. A relapse regimen included IV ifosfamide, cytarabine, and IT methotrexate. Results. We treated 12 children with 13 NHLs. Nine (75%) achieved a complete response (CR), 2 (17%) had a partial response (PR), and 1 (8%) did not respond to the primary chemotherapy regimen. Patients who had a PR received the relapse regimen; one subsequently achieved CR and one did not respond. One (8%) patient relapsed 8 months after completion of the primary regimen. Overall median survival time was 28 months. Seven (58%) patients died, one due to progressive NHL and 6 as a consequence of their underlying illnesses. There was a significant difference in survival (p<0.01) between HIV-infected children with and without AIDS-defining conditions prior to the diagnosis of NHL. Only patients without AIDS-defining conditions at the time of diagnosis are currently alive. Grade 4 hematologic toxicity occurred in 8 (75%) and non-hematologic toxicity in 3 (25%) of the patients who received the primary regimen. Relapse chemotherapy was associated with a significantly higher incidence of toxicity. No opportunistic infections occurred during chemotherapy. Conclusions. Our treatment approach for NHL in immunocompromised children was well tolerated and effective. The treatment for lymphoma did not appear to modify the course of their underlying conditions.
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Published In
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Publication Date
Volume
Issue
Start / End Page
Related Subject Headings
- Pediatrics