The Société Française d'Oncologie Pédiatrique 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.

Abstract

This study was undertaken to show that a high survival rate can be obtained in B-cell (Burkitt and large B-cell) lymphoma and L3 leukemia with multiagent chemotherapy adapted to the tumor burden (stage, resection status, percentage of blasts in bone marrow, and central nervous system [CNS] involvement) and early response to chemotherapy, to investigate actual prognostic factors, and to see if large B-cell lymphoma can be treated with the same regimen as Burkitt lymphoma. Patients were classified into 3 risk groups. Group A (resected stage I and abdominal stage II) received 2 courses of vincristine, cyclophosphamide, doxorubicin, and prednisone. Group B (patients not eligible for groups A or C) received 5 courses of chemotherapy with, in addition, high-dose methotrexate, 3 g/m(2) over 3 hours; infusional cytarabine; and intrathecal (IT) methotrexate. Group C (patients with CNS involvement and acute lymphoblastic leukemia with at least 70% of blasts in bone marrow) received 8 courses with, in addition, high-dose methotrexate, 8 g/m(2); high-dose cytarabine; etoposide; and triple IT. Except in group A, treatment started with a prephase (COP, low-dose vincristine and cyclophosphamide). It was intensified for patients who did not respond to COP in group B and any patient with residual viable cells after the consolidation phase. A total of 561 patients were enrolled in the SFOP LMB89 protocol (July 1989-June 1996). Five-year survival is 92.5% (95% confidence interval [CI], 90%-94%) and event-free survival (EFS) 91% (95% CI, 89%-93%). EFS is 98% (95% CI, 90%-100%), 92% (95% CI, 89%-95%), and 84% (95% CI, 77%-90%) for group A, B, and C, respectively. In group B, multivariate analysis of prognostic factors showed that a lactate dehydrogenase level more than 2-fold the normal value, no response after COP, and age of at least 15 years were associated with a lower EFS. CNS involvement was the only prognostic factor in group C. (Blood. 2001;97:3370-3379)

• Authors: C Patte, A Auperin, J Michon, H Behrendt, G Leverger, D Frappaz, P Lutz, C Coze, Y Perel, M Raphaël, M J Terrier-Lacombe, Société Française d'Oncologie Pédiatrique
• Journal: Blood (Blood) Vol. 97 Issue 11 Pg. 3370-9 (Jun 01 2001) ISSN: 0006-4971 [Print] United States
• PMID: 11369626 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Cytarabine
• Vincristine
• Etoposide
• Doxorubicin
• Cyclophosphamide
• Leucovorin
• Prednisone
• Hydrocortisone
• Methotrexate

Topics

• Adolescent
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Child
• Child, Preschool
• Cyclophosphamide (adverse effects, therapeutic use)
• Cytarabine (adverse effects, therapeutic use)
• Doxorubicin (adverse effects, therapeutic use)
• Etoposide (adverse effects, therapeutic use)
• Female
• Humans
• Hydrocortisone (adverse effects, therapeutic use)
• Infant
• Leucovorin (adverse effects, therapeutic use)
• Lymphoma, B-Cell (drug therapy, mortality, pathology)
• Male
• Methotrexate (adverse effects, therapeutic use)
• Neoplasm Staging
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (drug therapy, mortality, pathology)
• Prednisone (adverse effects, therapeutic use)
• Prognosis
• Recurrence
• Remission Induction
• Survival Rate
• Vincristine (adverse effects, therapeutic use)