Treatment Results of the Tpog-Nhl92 Protocols for Childhood Non-Hodgkin's Lymphomas in Taiwan: A Report from the Taiwan Pediatric Oncology Group ( Tpog)

A nation-wide chemotherapeutic trial for childhood non- Hodgkin's lymphoma (NHL) was conducted by the Taiwan Pediatric Oncology Group (TPOG) . Four TPOG-NHL92 protocols based on stage and histology were activated in 1992: TPOG-92 LD (treatment duration: 8 months) was used for localized ( stages I/II) NHL with any histology, 92LB (2 years), 92SNC ( 5 months), and 92LC (1 year) for advanced (stages III/IV) lymphoblastic (LB), small non-cleaved cell (SNC), and large cell (LC) lymphoma, respectively. From January 1992 through June 1998, 200 children with newly diagnosed NHL from 13 member hospitals of TPOG were enrolled. There were 140 boys and 60 girls. Their ages at diagnosis ranged from 2.4 months to 18.3 years with a median of 8.2 years. There were 54 (27 .3%) patients with LB, 94 (47.5%) with SNC including B-cell acute lymphoblastic leukemia (B-ALL), and 50 (25 .2%) with LC . Stages I, II, III, and IV (including B-ALL) of the disease comprised 5%, 10%, 43%, and 42% of cases, respectively. There were 176 patients eligible for evaluation of treatment results. The remission rate of induction was 82.4%, induction failed in 22 (12.5%) patients, and nine patients died during induction. As of August 31, 1999, 26 patients relapsed, six died during remission, one patient developed secondary acute myelomonocytic leukemia, and 105 patients remained in continuous remission with a median remission duration of 49 months. The event-free survival (EFS) at 7 years was 63.5%, 61.5% and 65% for LB, SNC, and LC groups (P = 0.8298). The 7-year EFS for stages I/II, III, and IV of the disease was 73%, 68.9%, and 50.3% (P = 0.0212), respectively. We concluded that following the strategy of stratification of therapy, only disease stages had prognostic significance in this study. More efforts are needed to improve our treatment results