Charlotte Rigaud1, Anne Auperin2, Anne Jourdain3, Stephanie Haouy4, Marie-Laure Couec5, Nathalie Aladjidi6, Virginie Gandemer7, Anne Lambliotte8, Geneviève Plat9, Judith Landman-Parker10, Jean Michon11, Thierry Leblanc12, Catherine Patte1, Veronique Minard-Colin1. 1. Department of Pediatric Oncology, Gustave Roussy Cancer Campus, Villejuif, France. 2. Department of Statistics, Gustave Roussy Cancer Campus, Villejuif, France. 3. Department of Pediatric Oncology and Haematology, University Hospital of Tours, Tours, France. 4. Department of Pediatric Oncology and Haematology, University Hospital of Montpellier, Montpellier, France. 5. Department of Pediatric Oncology and Haematology, University Hospital of Nantes, Nantes, France. 6. Department of Pediatric Oncology and Haematology, University Hospital of Bordeaux, Bordeaux, France. 7. Department of Pediatric Oncology and Haematology, University Hospital of Rennes, Rennes, France. 8. Department of Pediatric Oncology and Haematology, Centre Oscar Lambret, Lille, France. 9. Department of Pediatric Oncology and Haematology, University Hospital of Toulouse, Toulouse, France. 10. Department of Pediatric Oncology and Haematology, Hospital Armand Trousseau, Paris, France. 11. Department of Pediatric Oncology, Institut Curie, Paris, France. 12. Department of Pediatric Oncology and Haematology, Hospital Robert Debré, Paris, France.
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.
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.
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