Improved outcome in children with advanced stage B-cell non-Hodgkin's lymphoma (B-NHL): results of the United Kingdom Children Cancer Study Group (UKCCSG) 9002 protocol

Abstract

From July 1990 to March 1996, 112 children with stage III or IV B-cell non-Hodgkin's lymphoma (B-NHL) with up to 70% FAB L3-type blasts ( n = 42) in the bone marrow without central nervous system (CNS) disease were treated on the United Kingdom Children Cancer Study Group (UKCCSG) 9002 protocol (identical to the French LMB 84). The median age was 8.3 years. There were 81 boys and 31 girls. According to the extent of the primary disease, patients were sub-staged into three groups: IIIA with unresectable abdominal tumour ( n = 39); IIIB with abdominal multiorgan involvement ( n = 57) and IIIX with extra-abdominal primary lymphoma often presenting as pleural effusion ( n = 16). Univariate and multivariate analyses were carried out to evaluate the prognostic significance of lactate dehydrogenase (LDH) level at diagnosis, the sub-stage and the time to achieve complete remission (CR). With a median follow up of 48 months (range 12–92), the overall and event free survival (EFS) is 87% (95% confidence interval (CI) 79.2–92.1%) and 83.7% (95% CI 76.3–89.2%) respectively. Six patients (5.4%) never achieved CR, of whom one is alive following high-dose therapy. Eight patients (7.1%) relapsed after achieving CR, three are alive after second-line therapy. There were three early toxic deaths (2.7%), mainly from infection, and one late death from a second cancer. There was no significant difference in EFS according to LDH level at diagnosis, the sub-stage or the time to CR. This study confirms the overall good prognosis and low rate of toxic deaths in patients with advanced B-NHL treated with this intensive regimen. No significant difference in EFS according to the sub-stage, the time to achieve CR or LDH level at diagnosis making it difficult to identify a group that should not receive intensive therapy. © 2000 Cancer Research Campaign

Long-term results of the first Italian Association of Pediatric Hematology and Oncology protocol for the treatment of pediatric B-cell non-Hodgkin lymphoma (AIEOP LNH92)

“…Seven patients with recurrent disease received successful intensification treatment followed by hematopoietic stem cell rescue; the resultant rescue rate was relatively high compared with the rescue rates reported in other studies. 7,20 Only two patients in the current study had CNS-positive disease, and both were cured. Ommaya reservoir implantation was not performed for either of these patients; instead, intrathecal therapy was administered via lumbar puncture.…”

“…7,9,20 In particular, we observed EFS rates of 86.9% in the R2 group and 75.1% in the R3 group, compared with 96% and 78%, respectively, in the BFM90 study, which also included patients with B-cell leukemia. This difference may be partially attributable to the smaller cohort size in the current study, but it certainly also is attributable to the higher prevalence of toxicity-related death in the current series (3.5%) compared with the BFM series (ϳ2%).…”

The Societe Francaise d'Oncologie Pediatrique LMB89 protocol: highly effective multiagent chemotherapy tailored to the tumor burden and initial response in 561 unselected children with B-cell lymphomas and L3 leukemia

“…Notably, stages and "substages" in this group did not appear to be predictive of outcome, as found in the UKCCSG 9002 study with the same protocol given to the same category of stage III and IV patients. 31 On the other hand, the LDH level was a prognostic factor in our series. However, the difference in EFS between patients with a low and a high LDH level was only 5.5% (95% vs 89.5%).…”

Non-Hodgkin lymphoma and pre-existing conditions: spectrum, clinical characteristics and outcome in 213 children and adolescents

“…Of the 213 patients, 174 (82%) were treated according to protocols of the EICNHL, NHL-BFM SG, AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica), UKCCSG (United Kingdom Children's Cancer SG), SFOP (Société Française d'Oncologie Pédiatrique), EORTC (European Organisation for Research and Treatment of Cancer), COG (Children's Oncology Group), and JPLSG (Japanese Pediatric Leukemia/Lymphoma SG). [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] The remaining 39 patients (18%) received CHOP±ritux-imab, COP±rituximab, rituximab only, or miscellaneous treatments. The survey asked for information about dose reductions, suspension of chemotherapy elements or single drugs, and individualized therapy approaches.…”