| Abstract | The prognosis for higher risk childhood B-cell non-Hodgkin lymphoma has improved over the past 20 years but the optimal intensity of treatment has yet to be determined. Children 21 years old or younger with newly diagnosed B-cell non-Hodgkin lymphoma/B-cell acute lymphoblastic leukemia (B-NHL/B-ALL) with higher risk factors (bone marrow [BM] with or without CNS involvement) were randomized to standard intensity French-American-British/Lymphoma Malignancy B (FAB/LMB) therapy or reduced intensity (reduced cytarabine plus etoposide and deletion of 3 maintenance courses M2, M3, M4). All patients with CNS disease had additional high-dose methotrexate (8 g/m2) plus extra intrathecal therapy. Fifty-one percent had BM involvement, 20% had CNS involvement, and 29% had BM and CNS involvement. One hundred ninety patients were randomized. The probabilities of 4-year event-free survival (EFS) and survival (S) were 79% +/- 2.7% and 82% +/- 2.6%, respectively. In patients in remission after 3 cycles who were randomized to standard versus reduced-intensity therapy, the 4-year EFS after randomization was 90% +/- 3.1% versus 80% +/- 4.2% (one-sided P = .064) and S was 93% +/- 2.7% versus 83% +/- 4.0% (one-sided P = .032). Patients with either combined BM/CNS disease at diagnosis or poor response to cyclophosphamide, Oncovin [vincristine], prednisone (COP) reduction therapy had a significantly inferior EFS and S (P < .001). Standard-intensity FAB/LMB therapy is recommended for children with high-risk B-NHL (B-ALL with or without CNS involvement). |
| Authors | Mitchell S Cairo, Mary Gerrard, Richard Sposto, Anne Auperin, C Ross Pinkerton, Jean Michon, Claire Weston, Sherrie L Perkins, Martine Raphael, Keith McCarthy, Catherine Patte, FAB LMB96 International Study Committee
(Affiliation: Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY 10032, USA. mc1310 at columbia.edu)
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| Journal | Blood
(Blood)
Vol. 109
Issue 7
Pg. 2736-43
(Apr 1 2007)
ISSN: 0006-4971 United States |
| PMID | 17138821
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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| Topics |
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols
(adverse effects, therapeutic use)
- Bone Marrow Neoplasms
(drug therapy, mortality)
- Burkitt Lymphoma
(drug therapy, mortality)
- Central Nervous System Neoplasms
(drug therapy, mortality)
- Child
- Child, Preschool
- Disease-Free Survival
- Female
- Humans
- Infant
- Lymphoma, B-Cell
(drug therapy, mortality)
- Male
- Risk Factors
- Survival Rate
- Treatment Failure
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