Treatment of pediatric B-cell non-Hodgkin's lymphomas at the Motol Hospital in Prague, Czech Republic: Results based on the NHL BFM 90 protocols
Abstract
Malignant non-Hodgkin's lymphomas (NHL) of childhood and adolescence are a heterogeneous group of diseases originating from the lymphoid cells. Unlike adults with non-Hodgkin's lymphoma, children typically have extranodal disseminated disease of high grade (Burkitt's lymphoma, large cell lymphoma, or lymphoblastic lymphoma).
This study was conducted to determine the feasibility of treating children in the Czech Republic with B-cell non-Hodgkin's lymphomas according to very intensive protocols based on the German Berlin Frankfurt Munster (BFM) NHL 90 study. Treatments are divided in the BFM studies according to "B" and "non-B " immunophenotypes, The authors report only those treated according to the BFM B-cell protocol.
From 1991 through 1997 eighty-two patients less than 18 years with NHL were admitted to the department. Seventy-three of them were classified as B-cell lymphoma and 54 were thus eligible for the BFM B-cell treatment.
The entire group consisted of 38 males and 16 females (ratio 2.38). Median age was 11.6 years.
Twelve had stage I disease, 3 stage 11, 30 stage Ill; and 9 stage IV lymphoma. There were 21 patients with Burhitt's lymphoma, 29 with large cell lymphoma, of which 5 were patients with MALT Il lymphoma.
In 3 cases B-cell NHL was not further classified and one child had a mediastinal B lymphoma. Patients were furher stratified according to clinical stage and lactate dehydrogenase (LDH) level.
Therapy consisted of a prephase and short (2, 4, or 6 courses), intensive 5-day therapy with 6 drugs. The probability of event-free survival (pEFS)fm the entire group was 74% and overall survival at 5 years was 80%.
There was a significantly better outcome for children classified as stage I. No difference was observed between the EFS of stage III and IV patients.
Four patients died from treatment-related complications in complete remission. Treatment results were not identical between NHL subtypes, with large cell lymphoma patients doing significantly better (pEFS 90%, p =.008).
The use of protocols based on BFM 90 study was feasible at this center. The treatment results are approximately 10% lower than those reported by BFM investigators, but comparable to results from other centers.