Relapsed or refractory anaplastic large-cell lymphoma in children and adolescents after Berlin-Frankfurt-Muenster (BFM)-type first-line therapy: a BFM-group study.

Abstract

PURPOSE:

To evaluate risk factors for outcome in children and adolescents with relapse of anaplastic large-cell lymphoma (ALCL) after comparable first-line therapy.

PATIENTS AND METHODS:

We analyzed a population-based cohort of 74 children with relapsed ALCL after Berlin-Frankfurt-Muenster-type first-line therapy between April 1990 and December 2003. The recommended salvage strategy was reinduction chemotherapy followed by autologous hematopoietic stem-cell transplantation (SCT).

RESULTS:

With a median follow-up time of 8.4 years (range, 4.5 to 16.4 years), the 5-year overall survival (OS) rate after first relapse was 57% ± 6%. Survival correlated with time of relapse and clinically advanced dissemination. Five-year OS of 16 patients who experienced progression during first-line therapy was 25% ± 11% compared with 66% ± 6% for 58 patients with a later relapse (P = .002). Five-year OS of 11 patients with bone marrow or CNS involvement was 27% ± 13% compared with 62% ± 6% for 63 patients without involvement (P = .001). Five-year event-free survival (EFS) and OS of 39 children who received the recommended autologous SCT were 59% ± 8% and 77% ± 7%, respectively. EFS after autologous SCT was significantly associated with time to relapse (progression: n = 3; EFS, 0; later relapse: n = 36; EFS, 64% ± 8%; P = .014) and CD3 expression (CD3 negative: n = 25; EFS, 72% ± 9%; CD3 positive: n = 11; EFS, 18% ± 12%; P < .001), but not with site of relapse, conditioning regimen, or graft manipulation. No relapses occurred among 10 patients with relapsed CD3-positive ALCL treated with allogeneic SCT.

CONCLUSION:

Reinduction chemotherapy followed by autologous SCT proved feasible and efficacious for patients with a first relapse of CD3-negative ALCL after first-line therapy. Patients with progression during first-line therapy or relapsed CD3-positive ALCL may benefit from allogeneic SCT.

• Authors: Willi Woessmann, Martin Zimmermann, Meike Lenhard, Birgit Burkhardt, Claudia Rossig, Bernhard Kremens, Peter Lang, Andishe Attarbaschi, Georg Mann, Ilske Oschlies, Wolfram Klapper, Alfred Reiter
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 29 Issue 22 Pg. 3065-71 (Aug 01 2011) ISSN: 1527-7755 [Electronic] United States
• PMID: 21709186 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Child
• Child, Preschool
• Disease-Free Survival
• Feasibility Studies
• Female
• Hematopoietic Stem Cell Transplantation
• Humans
• Immunohistochemistry
• Immunophenotyping
• Lymphoma, Large-Cell, Anaplastic (drug therapy, surgery)
• Male
• Predictive Value of Tests
• Prognosis
• Recurrence
• Remission Induction
• Risk Assessment
• Risk Factors
• Salvage Therapy (methods)
• Transplantation, Autologous
• Treatment Outcome