Childhood and adolescent large-cell lymphoma (LCL): a review of the Children's Cancer Group experience.
We reviewed the clinical characteristics, treatment, and outcome of 67 children with localized and 212 with disseminated large-cell lymphoma (LCL) treated during a 20-year period in 5 consecutive Children's Cancer Group (CCG) non-Hodgkin's lymphoma (NHL) trials. Clinical outcomes for patients treated on the four earlier studies with moderate-dose chemotherapy administered over 12-18 months were compared with patients treated most recently with short, intensive therapy. Median age at diagnosis was 12 years (range: 0-19 years). Male to female ratio was 1.8:1.0. Five-year event-free survival (EFS) was 92% +/- 3.3% and 50 +/- 3.5% for patients with localized LCL and disseminated LCL, respectively. After adjustment for lactate dehydrogenase (LDH), age at diagnosis, and BM involvement, short and intensive therapy as delivered on the most recent study, CCG-5911, was associated with an improved outcome (P< 0.05) compared to the four previous studies. Elevated LDH (> or = 500 IU/L) at diagnosis and young age (<5 years) were both significant independent predictors of poorer long-term EFS (P< 0.05). Long-term survival after relapse or other treatment failure was only 31% +/- 4.7%. In summary, more recent shorter and intense therapy appears to be associated with superior event-free survival for children and adolescents with disseminated LCL. Large numbers of patients treated with shorter and intense therapy are required to confirm these preliminary observations.
Cairo
Mitchell S
MS
Department of Pediatrics, Columbia University, New York, New York, USA. mc1310@columbia.edu
Sposto
Richard
R
Hoover-Regan
Margo
M
Meadows
Anna T
AT
Anderson
James R
JR
Siegel
Stuart E
SE
Kadin
Marshall E
ME
Kjeldsberg
Carl R
CR
Wilson
John F
JF
Perkins
Sherrie L
SL
Lones
Mark A
MA
Morris
Erin
E
Finlay
Jonathan L
JL
D000293:Adolescent; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D002490:Central Nervous System / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007770:L-Lactate Dehydrogenase / Q000097:blood; D015993:Life Tables; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D009363:Neoplasm Proteins / Q000097:blood; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D009363:Neoplasm Proteins; D007770:L-Lactate Dehydrogenase