Role of staging in childhood non-Hodgkin's lymphoma

Childhood non-Hodgkin's lymphoma is characterized by a high incidence of leukemic transformation. A retrospective analysis of this incidence in 227 children is provided. In an attempt to identify factors associated with this phenomenon, the extent of disease in 30 recently diagnosed patients was determined by means of a modified Ann Arbor staging system. Concurrently, the staging system was utilized for the delivery of a new treatment program: chemotherapy was administered to all patients, and those with stage I and II disease also received radiation therapy to sites of bulk tumor. An overall disease-free survival of 75% was achieved. No patient with stage I disease converted to acute leukemia. The data suggest that the major utility of staging is the delineation of anatomic sites of bulk tumor. The chemotherapeutic program utilized in these patients is outlined.