Members of the Childrens Cancer Study Group treated 234 eligible patients in a randomized trial designed to study the relative effectiveness of two therapy programs for the treatment of childhood and adolescent non-Hodgkin's lymphoma. Two chemotherapeutic strategies were compared: a 4-drug regimen (COMP) and a 10-drug regimen (modified LSA2-L2). Failure-free survival for all patients was 60 per cent at 24 months. In patients with disseminated disease treatment success was influenced by both the histologic subtype of disease and the therapeutic regimen followed. The 10-drug program was more effective than the 4-drug program in patients with disseminated lymphoblastic disease (two-year failure-free survival rate, 76 vs. 26 per cent, respectively; P = 0.0002), whereas the 4-drug program was more effective than the 10-drug program in those with nonlymphoblastic disease (57 vs. 28 per cent, respectively, P = 0.008). The less toxic, more easily administered 4-drug regimen was as effective as the 10-drug regimen in patients with localized disease (89 vs. 84 per cent, respectively). (N Engl J Med. 1983; 308:559–65.) Considerable progress was made during the 1960s in the treatment of some pediatric cancers — most notably, Wilms' tumor and acute lymphoblastic leukemia. This was not true for the non-Hodgkin's lymphomas of childhood. During the 1960s, only 15 per cent of children with non-Hodgkin's lymphoma could be expected to survive longer than two years.1 The first indications that the use of multiagent therapy could control disease over the long term came from Djerassi and Kim, who obtained promising results with intravenous methotrexate combined with other agents2; from Ziegler, who reported long-term disease control in both American and African patients.
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