Therapy for childhood non-Hodgkin's lymphomas, nonlymphoblastic type. Review of recent studies and current recommendations.

Childhood non-Hodgkin's lymphomas can be divided into two broad groups based on histologic findings: lymphoblastic and nonlymphoblastic. Lymphoblastic lymphomas often appear with a mediastinal mass and have a propensity for relapse in the bone marrow and CNS. Nonlymphoblastic lymphomas occur primarily in the abdomen and head-neck region. Relapses tend to occur within the first year and may be either local or systemic. Marrow and/or CNS involvement at diagnosis, bulk disease (reflected as elevated serum lactic dehydrogenase levels), and mediastinal occurrences are adverse prognostic features for nonlymphoblastic lymphomas. Chemotherapy is the treatment of choice for both types of childhood non-Hodgkin's lymphomas. In general, radiation therapy is not necessary for optimal treatment of these tumors. Localized non-Hodgkin's lymphomas of either histologic type are highly curable with short-course chemotherapy. Disseminated non-Hodgkin's lymphomas, particularly those with marrow and/or CNS involvement, remain a major treatment challenge.