RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing
so they stop growing or die. Combining more than one drug and using drugs in different ways
may kill more tumor cells.
PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy in treating
pediatric patients with stage III or stage IV non-Hodgkin's lymphoma.
OBJECTIVES: I. Assess the feasibility of treating all histologic subgroups of pediatric
non-Hodgkin's lymphoma on one protocol, with the addition of asparaginase during the
induction and consolidation phases for diffuse lymphoblastic lymphoma and T-cell, large
noncleaved cell diffuse lymphoma. II. Assess whether intensification of cyclophosphamide
during induction therapy will achieve a complete response rate of 95% in 1 to 1.5 months for
all histologies. III. Assess whether achieving remission induction in 1 month, administering
cytarabine/methotrexate by continuous infusion during consolidation therapy, and increasing
the number of intrathecal methotrexate injections throughout protocol therapy decreases
central nervous system relapse in these patients. IV. Assess whether a 5-year
recurrence-free survival of 85% is achievable for all histologies on this protocol. V.
Assess whether duration of maintenance chemotherapy may be stratified by stage and histology
of disease to avoid unnecessarily prolonged chemotherapy.
OUTLINE: The following acronyms are used: ARA-C Cytarabine, NSC-63878 ASP Asparaginase,
NSC-109229 CF Leucovorin, NSC-3590 CTX Cyclophosphamide, NSC-26271 DM Dexamethasone,
NSC-34521 DNR Daunorubicin, NSC-82151 G-CSF Granulocyte Colony-Stimulating Factor,
NSC-614629 LBL Lymphoblastic Lymphoma LCALKi1B Large Cell Anaplastic B-cell Lymphoma
LCALKi1T Large Cell Anaplastic T-cell Lymphoma LCL Large Cell Lymphoma Mesna Mercaptoethane
Sulfonate, NSC-113891 MTX Methotrexate, NSC-740 TMP-SMX Trimethoprim-Sulfamethoxazole VCR
Vincristine, NSC-67574 VP-16 Etoposide, NSC-141540 Induction: 2-Drug Combination Systemic
Chemotherapy plus Single-Agent Intrathecal Chemotherapy followed by 2- or 3-Drug Combination
Systemic Chemotherapy plus Single-Agent Intrathecal Chemotherapy. Part I: CTX/DNR; plus IT
ARA-C; followed by Part II: DM/VCR; plus ASP for patients with LBL, T-cell LCL, or LCALKi1T;
plus IT MTX. Consolidation: 2- or 3-Drug Combination Systemic Chemotherapy with Leucovorin
Rescue followed by 2- or 3-Drug Combination Systemic Chemotherapy. Part I: ARA-C/MTX with
CF; plus ASP for patients with LBL, T-cell LCL, or LCALKi1T; followed by Part II:
ARA-C/VP-16; plus, for patients with LBL, T-cell LCL, or LCALKi1T. Maintenance. Single-Agent
Systemic Chemotherapy with Leucovorin Rescue plus Single-Agent Intrathecal Chemotherapy
followed sequentially by 3 2-Drug Combination Systemic Chemotherapy Regimens. Part I: MTX;
with CF; plus IT MTX; followed by Part II: CTX/VCR; followed by Part III: ARA-C/VP-16;
followed by Part IV: DNR/DM.
PROJECTED ACCRUAL: 25 patients/stratum are expected to be accrued over 3 years. This study
will be reviewed for early closure if more than 1 patient has PD.
DISEASE CHARACTERISTICS: See General Eligibility Criteria
PATIENT CHARACTERISTICS: See General Eligibility Criteria