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The value of adding rituximab to chemotherapy in children with aggressive B-cell non-Hodgkin lymphoma (B-NHL) is still insufficiently studied. We enrolled 231 patients [mean age 9 years old (range 2-17); male:female ratio 3Á4:1] with Burkitt (BL, 179 patients, 76Á7%), diffuse large B-cell (32 patients, 14%), primary mediastinal B-cell (14 patients, 6%), and other (6 patients, 2Á6%) B-cell lymphomas in a prospective study of immunochemotherapy. Stages were I-II in 32% and III-IV in 68% of the patients. Four doses of 375 mg/m 2 rituximab were added to the Berlin-Frankfurt-Munster-NHL-90-like chemotherapy, with methotrexate being reduced or omitted in the first 2 induction blocks. The complete remission rate was 100% in limited-stage and 91Á4% in advanced-stage patients. Five advanced-stage patients (2Á2%) died in induction and 1 patient with stage 2 B-NHL died in remission; 11 patients in the high-risk group progressed on therapy (3 non-BL are alive after salvage) and 5 relapsed. Sixteen patients (9Á7%) with advanced stage disease proceeded to transplant. With a median follow-up of 46 months, 98Á5 AE 1% of patients with limited disease and 88Á1 AE 2% (88Á1% in Risk Group 3; 82Á6% in Risk Group 4) in advanced stages are alive. This study confirmed that combined immunochemotherapy for B-lymphomas is highly effective in children, despite reducing the intensity of the induction blocks.

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