Comparison of treatment regimens for pediatric lymphoblastic non-Hodgkin's lymphoma: a Childrens Cancer Group study.

225

198

Therapy of lymphoblastic lymphoma (LL)has evolved with use of chemotherapy regimens modeled after those for acute lymphocytic leukemia (ALL). We treated 33 patients with LL with the intensive chemotherapy regimens hyper-CVAD (fractionated cyclophosphamide, vincristine, Adriamycin, and dexamethasone) or modified hyper-CVAD used for ALL at our institution. Induction consolidation was administered with 8 or 9 alternating cycles of chemotherapy over 5 to 6 months with intrathecal chemotherapy prophylaxis, followed by maintenance therapy. Consolidative radiation therapy was given to patients with mediastinal disease at presentation. No consolidation with autologous or allogeneic stem cell transplantation was performed. At diagnosis, 80% were T-cell immunophenotype, 70% were stages III to IV, 70% had mediastinal involvement, and 9% had central nervous system (CNS) disease. Of the patients, 30 (91%) achieved complete remission, and 3 (9%) achieved partial response. Within a median of 13 months, 10 patients (30%) relapsed or progressed. Estimates for 3-year progression-free and overall survival for the 33 patients were 66% and 70%, respectively. Estimates for the patients with known T-cell immunophenotype were 62% and 67%, respectively. No parameters (eg, age, stage, serum lactate dehydrogenase [LDH], ␤ 2 microglobulin) appeared to influence outcome except for CNS disease at presentation. Modification of the hyper-CVAD regimen with anthracycline intensification did not improve outcome. Other modifications of the program could include incorporation of monoclonal antibodies and/or nucleoside analogs, particularly for slow responders or those with residual mediastinal

Section: Discussionmentioning

confidence: 99%

Outcome with the hyper-CVAD regimens in lymphoblastic lymphoma

Thomas

O’Brien

Cortes

et al. 2004

225

198

“…In one study, 31 of 34 mediastinal relapses occurred in patients who had received 15 Gy local irradiation. 24 On the other hand, in the BFM study on childhood T-LBL no mediastinal irradiation was performed and the local recurrence rate (7%) was still very low. 1 Intensive treatment with HDMTX during consolidation specifically designed as "extracompartment protocol" may have contributed to this result.…”

Section: T-lymphoblastic Lymphoma In Adults 4383mentioning

confidence: 99%

Outcome of adult patients with T-lymphoblastic lymphoma treated according to protocols for acute lymphoblastic leukemia

Hoelzer

Gökbuget

Digel

et al. 2002

190

178

We treated 45 adult patients with T-lymphoblastic lymphoma (T-LBL) (age range 15-61 years) with 2 protocols designed for adult acute lymphoblastic leukemia (ALL). An encouraging cure rate of 90% was recently reported for T-LBL in children treated with a similar approach. In our study, an 8-drug standard induction was administered over 8 weeks including prophylactic cranial (24 Gy) and mediastinal irradiation (24 Gy) followed by consolidation and reinduction therapy. At diagnosis, 91% of the 45 patients showed a mediastinal tumor and 40% had pleural/pericardial effusions; 73% of the patients had stage III/IV disease. Overall, 42 patients (93%) achieved a complete remission (CR), 2 patients (4%) achieved a partial remission, and 1 patient (2%) died during induction. In patients with stage I-III disease (n ‫؍‬ 18) the CR rate was 100% compared with 89% in stage IV (n ‫؍‬ 27). There were 15 patients who relapsed (36%) within 12 months. The majority of relapses (47%) occurred in the mediastinum (n ‫؍‬ 7) despite mediastinal irradiation with 24 Gy in 6 out of 7 patients. The estimates for overall survival, continuous CR, and disease-free survival at 7 years are 51%, 65%, and 62%, respectively. Stage, age, lactate dehydrogenase, and all other parameters had no influence on achievement of CR or outcome. This study demonstrates in a large cohort of patients with adult T-LBL that a high CR rate and a favorable outcome can be achieved with an ALL-type regimen. Mediastinal recurrence was the major obstacle and further improvement by intensification of chemotherapy, increased dose of mediastinal irradiation (36 Gy), and extended indications for stem cell transplantation seem to be required. (Blood. 2002; 99:4379-4385)

“…3,4 Although patients with limited disease may fare well, the outcome for those with poor-risk features (bone marrow or central nervous system involvement or lactate dehydrogenase [LDH] Ͼ 300 IU/L) or recurrent disease is generally less favorable. [5][6][7] Children have better outcomes than adults with poor-risk disease, [6][7][8][9] but recurrent disease is infrequently cured regardless of age. 10,11 Because of the high relapse rates and low cure rates for recurrent disease, both autologous and allogeneic hematopoietic stem cell transplantations are used in an attempt to improve survival.…”

Section: Introductionmentioning

confidence: 99%

A comparison of allogeneic and autologous bone marrow transplantation for lymphoblastic lymphoma

Levine

Harris

Loberiza

et al. 2003

142

plant (SCT) recipients had higher treatment-related mortality (TRM) at 6 months (18% versus 3%, P ‫؍‬ .002), and this disadvantage persisted at 1 and 5 years. Early relapse rates after alloSC transplantation and autoSC transplantation were similar, but significantly lower relapse rates were observed in alloSCT recipients at 1 and 5 years (32% versus 46%, P ‫؍‬ .05; and 34% versus 56%, P ‫؍‬ .004, respectively). No differences were noted in lymphoma-free survival rates between alloSC transplantations and autoSC transplantations (5-year rates 36% versus 39%, P ‫؍‬ .82). AutoSCT recipients had higher overall survival at 6 months (75% versus 59%, P ‫؍‬ .01), but survival did not significantly differ between the 2 groups at 1 and 5 years (60% versus 49%, P ‫؍‬ .09; 44% versus 39%, P ‫؍‬ .47, respectively). Multivariate analyses to account for confounding factors confirmed these results. Independent of SCT type, BM involvement at the time of transplantation and disease status more advanced than first complete remission were associated with inferior outcomes. In summary, alloSC transplantation for LBL is associated with fewer relapses than with autoSC transplantation, but higher TRM offsets any potential survival