A combination of thioguanine, procarbazine, lomustine, and vincristine (TPCV) has shown a nonsignificant trend toward higher rates of 5-year event-free survival when compared with the combination of vincristine and carboplatin in NF1 patients. 2 , 9 , 84 However, because lomustine and procarbazine are associated with a heightened risk of secondary leukemia, their use should be avoided in patients with NF1 a
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