[Treatment strategies in malignant non-Hodgkin lymphomas in childhood].

The prognosis of malignant non-Hodgkin lymphoma (NHL) in childhood has significantly improved due to stage-depending intensity and duration of treatment as well as the use of different therapeutic managements in non-B and B-lymphoma. According to the results of two consecutive BFM-studies (BFM-NHL 75/81, n = 116; BFM 81/83, n = 95) a curative rate of 70% may be reached with an acceptable therapeutic toxicity (under 2% deaths in the BFM-NHL-study 81/83). This result was already achieved in non-B-NHL in the study 75/81 by using an ALL therapy protocol. An improvement in the outcome of B-NHL was only achieved in the study 81/83 by introducing a new therapeutic concept including a combination of other agents and by reducing the duration of treatment to 8 weeks (stage I and II) and to 20 weeks (stage III and IV), respectively. In contrast to the non-B NHL, the prognosis of B-NHL distinctly varies according to the localized (I and II) and disseminated stage (III and IV). The probability of eventfree survival in the localized stage of B-NHL is excellent in both BFM-studies (86-100%). In the disseminated stage of B-NHL the result is not satisfying so far (61% in the study 81/83 vs. 38% in the study 75/81). The relapse cascade in non-B NHL proceeds similar to ALL in childhood. No relapses have been observed within 5 years after diagnosis. Recurrence in B-NHL only occurs within the first year after diagnosis which justifies the reduction of treatment duration.