Non-Hodgkin's lymphomas of childhood and adolescence: results of a treatment stratified for biologic subtypes and stage--a report of the Berlin-Frankfurt-Münster Group.

Reiter, Alfred; Schrappe, Martin; Parwaresch, Reza; Henze, Guenter; Müller-Weihrich, Stefan; Sauter, S.; Sykora, Karl‐Walter; Ludwig, Wolf‐Dieter; Gadner, Helmut; Riehm, H

doi:10.1200/jco.1995.13.2.359

Cited by 298 publications

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“…Children with limited stage NHL have an excellent prognosis with an estimated 5-year event-free survival (EFS) of 90-95%. [10][11][12][13] The prognosis for advanced stage disease has also improved and varies based on subtype (60-90% 5-year EFS). 11,[13][14][15][16][17][18][19][20][21][22] HD Patients with HD commonly present with cervical or supraclavicular lymphadenopathy and most will present with some degree of mediastinal involvement.…”

Section: Nhlmentioning

confidence: 99%

“…Some data indicate that stem cell transplantation (SCT) should be considered as upfront therapy in patients with poor prognostic features and have little chance of cure with standard chemotherapy alone. 38,42 Poor prognostic features have been defined as (1) a delayed or partial response to first-line therapy, 13,22,43 (2) central nervous system or BM involvement at presentation 35 or (3) time to relapse from initial diagnosis. 44 Bureo et al 35 reported an expected EFS of 82.5% in a small group (n ¼ 13) of high-risk patients with these poor prognostic features who were consolidated with high-dose therapy followed by AutoSCT in CR1 (Table 1).…”

Section: Nhlmentioning

confidence: 99%

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Stem cell transplantation for pediatric lymphoma: past, present and future

Bradley

Cairo

2007

Bone Marrow Transplant

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Lymphoma is the third most common cancer in children p15 years of age. The prognosis for children with newly diagnosed chemosensitive non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) has improved significantly. However, in children with relapsed and refractory NHL, the prognosis is not as promising and the best treatment approach for this poor risk group continues to be a challenge. Between 25 and 30% of patients with advanced stage HD still relapse and in subsets of this group, the outcome is dismal. Aggressive chemotherapy followed by autologous bone marrow transplantation has been used with some improvement in survival. Some centers have investigated allogeneic stem cell transplantation in pediatric patients with recurrent/relapsed lymphoma. There is little consistency in therapeutic approaches and there is no formal recommendation on the best approach for this poor prognostic subgroup. We illustrate the reported pediatric experience of transplantation for lymphoma and discuss how the results from these trials are influencing how we approach the treatment in certain subgroups of pediatric patients with relapsed/ refractory lymphoma.

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Section: Nhlmentioning

confidence: 99%

Section: Nhlmentioning

confidence: 99%

Stem cell transplantation for pediatric lymphoma: past, present and future

Bradley

Cairo

2007

Bone Marrow Transplant

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Section: Discussionmentioning

confidence: 99%

“…The LMB 86 protocol improved the disease-free survival further by increasing the dose of high-dose methotrexate and cytarabine and the frequency of intrathecal medications (Rubie et al, 1988). The significance of partial substitution of ifosfamide for cyclophosphamide in the German study is difficult to interpret, but has not significantly improved the results of treatment (Reiter et al, 1989(Reiter et al, , 1995.The role of radiotherapy to achieve local control in patients with CNS disease at presentation remains controversial. Avoidance of cranial irradiation would help to reduce long-term endocrine and neurological sequelae and is therefore desirable.…”

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confidence: 99%

Improved cure rate in children with B-cell acute lymphoblastic leukaemia (B-ALL) and stage IV B-cell non-Hodgkin's lymphoma (B-NHL) - results of the UKCCSG 9003 protocol

Atra

Gerrard²,

Hobson³

et al. 1998

Br J Cancer

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Improved cure rate in children with B-cell acute lymphoblastic leukaemia (B-ALL) February 1996, 35 patients with B-cell acute lymphoblastic leukaemia (B-ALL) 13 of whom had CNS disease and 28 patients with stage IV B-cell non-Hodgkin's lymphoma (B-NHL) 22 of whom had CNS involvement were treated with a short, intensive multiagent chemotherapy regimen (UKCCSG 9003 protocol) based on the French LMB 86 regimen. Fifty-five were boys. The age range was 11 months to 16.5 years (median 8.4 years). Chemotherapy included cyclophosphamide, vincristine, daunorubicin, high-dose methotrexate (COPADM) and etoposide/high-dose cytarabine (CYVE) with frequent intrathecal (i.t.) triple therapy (methotrexate, cytarabine and hydrocortisone). Cranial irradiation (24 Gy in 15 fractions) was recommended in patients with overt CNS disease. One patient with WiskottAldrich syndrome was withdrawn after entry and has been excluded from the analysis. Ten patients (16%) have relapsed (CNS, four; BM, two; combined CNS and BM, three; and jaw, one) 4-11 months after diagnosis and two patients never achieved complete remission (CR). All have died. In seven of the patients who relapsed, treatment had been modified or delayed because of poor clinical condition. Seven patients (11 %) died of toxicity 11 days to 4 months after diagnosis. The cause of death was sepsis (n = 5) or sepsis with renal failure (n = 2). With a median follow-up of 3.1 years from diagnosis (range 9 months to 6.3 years), 43 patients (69%) survive in CR. This study confirms the effectiveness of this regimen with regard to the relapse rate (16%), although the rate of toxic death is of concern.Keywords: high risk; paediatric cancer; B-cell acute lymphoblastic leukaemia; B-cell non-Hodgkin's lymphomaThe treatment of B-NHL in children is one of the success stories in paediatric oncology. The cure rate has increased from less than 20% before 1980 (Al-Attar et al, 1979) to over 70% in the 1980s and 1990s (Philip et al, 1982;Al-Attar et al, 1986;Patte et al, 1990). Recent studies have concentrated on improving outcome in the remaining poor-risk subgroups (Hann et al, 1988;Patte et al, 1991;Cairo et al, 1996), reducing early deaths by aggressive treatment of early renal and infectious complications (Lynch et al, 1977;Allegretta et al, 1985) and avoiding debulking surgery (Frappaz et al, 1988;Al-Attar et al, 1989).In 1986, the French paediatric oncology group (SFOP) introduced a regimen for poor-risk patients with increased intensity of early intrathecal (i.t.) therapy and the use of high-dose cytarabine (LMB 86). Before this, results in patients with CNS disease were disappointing, despite the use of craniospinal irradiation with chemotherapy regimen, which was very effective in less advanced disease (Philip et al, 1982;Chilcote et al, 1991). The subsequent results with LMB 86 were dramatic, with a survival rate over 70% (Rubie et al, 1988). Relapse of the underlying disease remains a major cause of treatment failure. The use of high-dose cytarabine and etoposide (CYVE) may he...

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“…It is usual to diagnose patients with ≥ 25% lymphoblasts in BM as having ALL, whereas patients with extra-medullary disease and less than 25% blasts in BM are diagnosed as LBL. 7,8 Clinical presentation varies according to immunophenotype. T-cell lymphoblastic lymphomas (T-LBL) most commonly involve the anterior mediastinum and supradiaphragmatic lymph nodes.…”

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confidence: 99%