TREATMENT OF CHILDREN AND ADOLESCENTSWITH NON-HODGKIN´S LYMPHOMA

Overview

Background.
To determine the feasibility and results of treatingchildren with non-Hodgkin´s lymphomas (NHL)according to very intensive protocols based on the German Berlin Frankfurt Münster NHL 90study.Methods and Results. From 1991 until 1995 eighty two patients less than18 years of age with NHL were admittedto our department. Sixty three of them were eligible for the study. The entire groupconsisted of 43 males and 20females (ratio 2.1 : 1). Median age was 10 2/12 years. Eleven had stage I disease, 4 stageII, 29 stage III and 19 stageIV disease. Histologies represented were: large cell lymphoma 22, lymphoblastic lymphoma19, and Burkittlymphoma 10 patients. In 12 cases the immunophenotype was not further classified as toB-cell or T-cell subtype.Patients were stratified into the therapy groups „B“ or „non B“ according tohistopathology, clinical stage and LDHlevel. Therapy for the B group consisted of 2, 4 or 6 courses of intensive 5 day pulses of6 drugs. Patients in thenon B group received the protocol for acute lymphoblastic leukemia including reinductionand CNS irradiation foradvanced 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 Btherapy group had a pEFS60% (p = 0.22). There was a significantly better outcome for children classified as stageI and II. There was nostatistical difference between stage III and IV. Treatment results were comparable betweenNHL subtypes, exceptfor large cell lymphomas, which did significantly better (pEFS 90%).Conclusions. The use of protocols based on BFM 90 study in the CzechRepublic was feasible. The pEFS areapproximately 10% lower than the German study but comparable to some other studies.Outcome for large celllymphomas was excellent. Reduction of treatment related complication and mortality rate aswell as more preciseclassification are required.

Klíčová slova:
non-Hodgkin lymphoma, children, BFM 90 protocols, treatment.