Combination Chemotherapy in Treating Children With Anaplastic Large Cell Lymphoma

DISEASE CHARACTERISTICS:

• Histologically proven standard-risk (SR) or high-risk (HR) anaplastic large cell lymphoma

  • SR disease defined by no involvement of the skin, mediastinum, liver, spleen, or lung

  • HR disease defined by any of the following:

    • Biopsy proven skin lesions (except skin lesions overlying an involved node or isolated skin disease)
    • Mediastinal involvement by x-ray or CT scan
    • Involvement of the liver (enlarged by at least 5 cm and/or nodular), spleen (enlarged and/or nodular), or lung (biopsy not needed for obvious lesions)
• Histologic or cytologic slides must be available for national pathology review for all patients not meeting the classical criteria for diagnosis (typical histopathology, immunohistochemistry: CD30 positive, endomysial antibody positive, nucleophosmin negative, anaplastic lymphoma kinase (ALK) positive (if available), null or T-immunophenotype) unless proven t(2;5)
• Must enroll within 1 week prior to beginning study regimen A
• No CNS involvement (CSF or cerebral tumor)

• First randomization (SR or HR disease):

  • Must have begun prephase therapy
  • No isolated primary skin disease
  • No low-risk disease defined as completely resected stage I disease

• Second randomization (HR disease only):

  • Must have completed first randomization therapy without disease progression

PATIENT CHARACTERISTICS:

Age:

• Under 22

Performance status:

• Not specified

Life expectancy:

• Not specified

Hematopoietic:

• See Disease Characteristics

Hepatic:

• See Disease Characteristics

Renal:

• Not specified

Pulmonary:

• See Disease Characteristics

Immunologic:

• No congenital immunodeficiency
• No AIDS

Other:

• No prior malignancy

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Not specified

Chemotherapy:

• Not specified

Endocrine therapy:

• Prior corticosteroids for anaplastic large cell lymphoma allowed if given for no more than 8 days

Radiotherapy:

• Not specified

Surgery:

• No prior organ transplantation

Other:

• No other prior therapy for anaplastic large cell lymphoma