Combination of dexamethasone, high-dose cytarabine, and carboplatin is effective for advanced large-cell non-Hodgkin lymphoma of childhood

Authors

  • John T. Sandlund MD,

    Corresponding author
    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, the University of Tennessee at Memphis College of Medicine, Memphis, Tennessee
    • Department of Hematology-Oncology, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105
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    • Fax: (901) 521-9005

  • Victor M. Santana MD,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, the University of Tennessee at Memphis College of Medicine, Memphis, Tennessee
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  • Melissa M. Hudson MD,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, the University of Tennessee at Memphis College of Medicine, Memphis, Tennessee
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  • Mihaela Onciu MD,

    1. Department of Pathology, St. Jude Children's Research Hospital, the University of Tennessee at Memphis College of Medicine, Memphis, Tennessee
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  • David Head MD,

    1. Department of Pathology, St. Jude Children's Research Hospital, the University of Tennessee at Memphis College of Medicine, Memphis, Tennessee
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  • Daryl J. Murry PharmD,

    1. Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, the University of Tennessee at Memphis College of Medicine, Memphis, Tennessee
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  • Raul Ribeiro MD,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, the University of Tennessee at Memphis College of Medicine, Memphis, Tennessee
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  • Dana Wallace MS,

    1. Department of Biostatistics, St. Jude Children's Research Hospital, the University of Tennessee at Memphis College of Medicine, Memphis, Tennessee
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  • Renee Rencher RN,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, the University of Tennessee at Memphis College of Medicine, Memphis, Tennessee
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  • Ching-Hon Pui MD

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, the University of Tennessee at Memphis College of Medicine, Memphis, Tennessee
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    • C-H Pui is the American Cancer Society Professor.


  • We dedicate this report in memory of John H. Rodman.

Abstract

BACKGROUND.

The purpose of the current study was to evaluate the activity and toxicity of dexamethasone, high-dose cytarabine, and carboplatin (DAC) combination therapy in children with newly diagnosed large-cell non-Hodgkin lymphoma (NHL) and to estimate the event-free and overall survival rates achieved when DAC is incorporated into a conventional regimen.

METHODS.

From 1991 to 1997, 20 boys and 5 girls aged 4.2 to 17.7 years who had stage III (according to the St. Jude staging system) (n = 21) or stage IV (n = 4) large-cell NHL were treated in this study. DAC therapy was administered at the beginning of the induction phase in 2 sequential cycles and incorporated throughout a continuation phase (modified from the ACOP+ regimen, which features doxorubicin, cyclophosphamide, vincristine, and prednisone) with doxorubicin, cyclophosphamide, vincristine, and dexamethasone. The total duration of treatment was approximately 10 months.

RESULTS.

DAC therapy yielded a response in 22 of 25 patients (88%; 95% confidence interval [95% CI], 68%-97%): complete remission in 13 cases (52%), and partial response in 9 (36%). After additional treatment with doxorubicin, cyclophosphamide, vincristine, and dexamethasone, complete remission was attained in 18 patients (72%) and partial remission in 3 (12%). The event-free survival rate (± the standard error [SE]) was 64% ± 9% and the overall survival rate was 80% ± 8% at 5 years.

CONCLUSIONS.

The results of the current study indicate that the DAC regimen is well tolerated and effective for pediatric patients with large-cell NHL. Cancer 2008. © 2008 American Cancer Society.

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