Outcome of relapse in children and adolescents with B-cell non-Hodgkin lymphoma and mature acute leukemia: A report from the French LMB study.

Abstract

INTRODUCTION:

In order to describe relapsed B-cell non-Hodgkin lymphoma and mature acute leukemia in children/adolescents treated with the Lymphomes Malins B (LMB) regimen and their outcome in the rituximab era, relapses in the French LMB2001 study were reviewed.

METHODS:

Between February 2001 and December 2011, 33 patients out of 773 (4.3%) relapsed; 27 had Burkitt lymphoma and six large B-cell histology. Median age at diagnosis was 10.1 years. One patient was initially treated in risk group A, 21 in group B, and 11 in group C.

RESULTS:

Median time to relapse after diagnosis was 4.5 months (range 2.4-13.6). Thirty-two patients received salvage therapy. Twenty-seven received rituximab mainly in addition to high-dose cytarabine and etoposide (n = 18) and/or ifosfamide, carboplatin, and etoposide (n = 7). First-line salvage chemotherapy response rate was 66% with 47% being complete remission (CR). Twenty-one patients received high-dose chemotherapy (HDC) followed by autologous (n = 13) or allogeneic (n = 8) transplant. With a median follow-up of 6.8 years, the 5-year survival rate after relapse was 36.4% (95% confidence interval [CI] 22-53%). Twelve patients were still alive; all but one (group A) received consolidation treatment. Achieving CR before consolidation was significantly associated with better survival, with a 5-year survival rate of 75% (95% CI 46.8-91.1%) for patients in CR before HDC, 33% (95% CI 9.7-70%) for patients in partial remission, and 0% for nonresponders (P = .033).

CONCLUSION:

Survival of children/adolescents with mature B-cell lymphoma/leukemia remains poor after relapse with no apparent improvement with rituximab. Response rates to salvage chemo-immunotherapies are insufficient and new drugs are urgently needed to improve disease control.

• Authors: Charlotte Rigaud, Anne Auperin, Anne Jourdain, Stephanie Haouy, Marie-Laure Couec, Nathalie Aladjidi, Virginie Gandemer, Anne Lambliotte, Geneviève Plat, Judith Landman-Parker, Jean Michon, Thierry Leblanc, Catherine Patte, Veronique Minard-Colin
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 66 Issue 9 Pg. e27873 (09 2019) ISSN: 1545-5017 [Electronic] United States
• PMID: 31207026 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)
• Copyright: © 2019 Wiley Periodicals, Inc.

Chemical References

• Cytarabine
• Rituximab
• Etoposide
• Carboplatin
• Ifosfamide

Topics

• Acute Disease
• Adolescent
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Burkitt Lymphoma (diagnosis, drug therapy, mortality)
• Carboplatin (administration & dosage)
• Child
• Child, Preschool
• Cytarabine (administration & dosage)
• Disease-Free Survival
• Etoposide (administration & dosage)
• Female
• Follow-Up Studies
• France
• Humans
• Ifosfamide (administration & dosage)
• Infant
• Leukemia (diagnosis, drug therapy, mortality)
• Lymphoma, Large B-Cell, Diffuse (diagnosis, drug therapy, mortality)
• Male
• Prospective Studies
• Recurrence
• Rituximab (administration & dosage)
• Survival Rate