TREATMENT OF CHILDREN AND ADOLESCENTS
WITH NON-HODGKIN´S LYMPHOMA (Results based on the NHL Berlin-Frankfurt-Münster 90 protocols)
P. Kavan, E. Kabičková,
1
P. Gajdoš, J. Koutecký, V. Šmelhaus,
J. Staňková,
2
K. L. McClain
Department of pediatric oncology, University hospital Motol, Prague, Czech Republic 1 Institute of public health, Prague, Czech Republic 2 Texas Children´s Cancer Center, Baylor College of Medicine, Houston, TX |
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Abstrakt:
Background. To determine the feasibility and results of treating
children with non-Hodgkin´s lymphomas (NHL)
according to very intensive protocols based on the German Berlin Frankfurt Münster NHL 90
study.
Methods and Results. From 1991 until 1995 eighty two patients less than
18 years of age with NHL were admitted
to our department. Sixty three of them were eligible for the study. The entire group
consisted of 43 males and 20
females (ratio 2.1 : 1). Median age was 10 2/12 years. Eleven had stage I disease, 4 stage
II, 29 stage III and 19 stage
IV disease. Histologies represented were: large cell lymphoma 22, lymphoblastic lymphoma
19, and Burkitt
lymphoma 10 patients. In 12 cases the immunophenotype was not further classified as to
B-cell or T-cell subtype.
Patients were stratified into the therapy groups „B“ or „non B“ according to
histopathology, clinical stage and LDH
level. Therapy for the B group consisted of 2, 4 or 6 courses of intensive 5 day pulses of
6 drugs. Patients in the
non B group received the protocol for acute lymphoblastic leukemia including reinduction
and CNS irradiation for
advanced stages. At a median follow-up of 35 months the probability of event free survival
(pEFS) at 5 years 70%
and overall survival 73% for entire group. For therapy group B pEFS was 76%. The non B
therapy group had a pEFS
60% (p = 0.22). There was a significantly better outcome for children classified as stage
I and II. There was no
statistical difference between stage III and IV. Treatment results were comparable between
NHL subtypes, except
for large cell lymphomas, which did significantly better (pEFS 90%).
Conclusions. The use of protocols based on BFM 90 study in the Czech
Republic was feasible. The pEFS are
approximately 10% lower than the German study but comparable to some other studies.
Outcome for large cell
lymphomas was excellent. Reduction of treatment related complication and mortality rate as
well as more precise
classification are required.
Klíčová slova:
non-Hodgkin lymphoma, children, BFM 90 protocols, treatment.
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