Pediatric Non-Hodgkin Lymphoma: A Retrospective 7-Year Experience in Children & Adolescents with Non-Hodgkin Lymphoma Treated in King Fahad Medical City (KFMC)

Abstract

Background: Non-Hodgkin's lymphoma is an aggressive malignant disease in children and adolescents. Although it is the fourth most common malignancy in Saudi children as reported in Saudi cancer registry, less information is available about pediatric Non-Hodgkin lymphoma and its outcome in Saudi Arabia. Study Objectives: To provide demographic data, disease characteristics, treatment protocol, toxicity and outcome of treatment in children & adolescents with Non-Hodgkin's lymphoma treated at KFMC. This study will form base line for future studies about pediatric Non-Hodgkin's lymphoma in KFMC, which may help to improve outcome for children with cancer in Saudi Arabia. Study Patients and Method: We retrospectively analyzed 28 children and adolescents diagnosed to have Non-Hodgkin's lymphoma at KFMC between December 2006 and December 2013, followed-up through June 2014. Results: Of the 28 patients, 10 (35.7%) girls and 18 (64.3%) boys, the male-to-female ratio was 1.8; 1. The median age at time of diagnosis was 6.4 years old (range 2.0 to 13.0 years old). The majority of patients (64.3%) were aged between 5 and 12 years old. Burkitt's lymphoma BL/BLL was the most common pathological subtype (60.7%), and DLBCL was the second most common subtype (21.4%). Abdominal and Retroperitoneal involvement was the most common primary site (78.6%) including the ileocaecal region. Most of the children presented with advanced Stage III and IV (75%), Cytogenetic study which screens specif-* Corresponding author. N. A. Mobark et al. 300 ically for the t (8; 14) (q24; q32) a characteristic genetic feature of Burkitt's Lymphoma was obtained from 21 patients, variant rearrangement was observed in 3/21 samples and complex chromosomes karyotype in addition to IGH/MYC rearrangement was observed in 2/21 samples. Those patients presented with very aggressive lymphoma and combined BM and CNS involvement. We use the French-American-British Mature B-Cell Lymphoma 96 Protocol (FAB LMB 96) for treatment fornewly diagnosed Mature B-Cell type NHL and high risk ALL CCG 1961 Protocol for lymphoblastic lymphoma and international Anaplastic Large Cell Lymphoma 99 Study Protocol for ALCL. The median follow-up in patients not experiencing an adverse event was 53.1 months. The estimated 3-year EFE and OS rates in the entire cohort of patients with newly diagnosed NHL treated in the KFMC were 85.2% and 89.2% respectively; Overall survival (OS) rate of patients with mature B-cell-NHL was 88.9%. Conclusion: The outcomes and survival in our small series appeared to be excellent compared with those reported in other international trials even though most of our patients presented in advanced stage of the disease. We feel that the importance of the current study is to document the relative distribution of various types of pediatric non-Hodgkin's lymphomas and age-specific distribution in different Histological subtypes.

Clinical profile and outcomes of Non-Hodgkin's lymphoma in children: A report from a tertiary care hospital from India

“…[21] LBL was the second most common subtype of NHL, comprising 15.4% of all NHLs similar to other studies. [14,[22][23][24] In a Brazilian epidemiologic study, LBL represented 36% of all NHLs and T-LBL was the most prevalent (60%) followed by B-LBL (25%) and the remaining (15%) were unclassified. [25] The overall frequency of T-LBL (6%-7.2%) in India [26,27] has been reported to be slightly higher than that in other countries.…”

“…The frequency of DLBCL was higher in other studies at 21.6%. [16,24,32] Occasionally, differentiation of BL can be difficult from high-grade DLBCL. Childhood DLBCL is biologically different from adult and has a good prognosis.…”

Pediatric Tonsil Cancer: A National and Institutional Perspective

“…This observation reflects the prevalence of Burkitt lymphoma in the pediatric population at large, reported in 1 institutional review to represent approximately 60.7% of all pediatric non-Hodgkin lymphoma cases. 15 Burkitt lymphoma is considered an aggressive subtype in which translocation of the c-myc proto-oncogene is seen in the majority of cases, leading to rapid unregulated cell growth. 16 Treatment is intensive chemotherapy, based on risk stratification.…”

“…This is consistent with the reported prevalence of DLBCL as the second most common subtype of pediatric non-Hodgkin lymphoma, representing about 21.4% of pediatric non-Hodgkin lymphoma cases. 15 Although patients with DLBCL present typically with abdominal disease, adenotonsillar lymphatic tissue is the second most common primary site. 20 Similar to Burkitt lymphoma, DLBCL is considered an aggressive non-Hodgkin lymphoma subtype requiring intensive chemotherapy as treatment.…”

Prognosis of Pediatric Non Hodgkin Lymphomas Treated With Fab/Lmb96 in Tertiary Center, Saudi Arabia

“…Nevertheless, in resource rich developing countries like KSA, where income may be high but the healthcare and demographic changes are more redolent of low-middle-income countries (LMIC), create a challenge situation. Unfortunately, a considerable proportion of pediatric patients come from low socio-economic background; they presented at advanced stage due to limited financial resources and this delay could affect their clinical outcome (Mobark et al, 2015). Scarce data is available in literature to describe the behavior of B-NHL among pediatric age group in our region.…”