Treatment of children with B-cell non-Hodgkin's lymphoma in developing countries: the experience of a single center in Brazil.
OBJECTIVE
To treat non-Hodgkin's B-cell lymphoma (B-NHL) in children with manageable toxicity-related morbidity and without any decrease in survival.


METHODS
Between January 1998 and April 2003, 53 consecutive patients (age 16 years or less) from a single institution were enrolled. The patients were stratified by risk factors (stage and LDH level) and treated with a BFM 86/90 (Berlin-Frankfurt-Münster)-based protocol with reduction of the methotrexate dose from 5 mg/m to 2 mg/m.


RESULTS
The mean age of the patients was 6 years (range 1-16 years). Seventy-two percent of the patients had lymphomas classified as Burkitt type, 11% as diffuse large cell lymphoma, and 6% as Burkitt-like lymphoma, and 11% were not classified. At a median follow-up of 35 months, 44 patients (83%) survived in complete remission. The event-free survival rate for all patients was 78% (SE = 0.07): 100% (SE = 0.0) for stage I/II patients and 74% (SE = 0.08) for stage III/IV patients. Six patients suffered initial treatment failure and one patient relapsed, all of whom died. There was only one death from sepsis related to treatment.


CONCLUSIONS
This strategy was very effective for treating B-NHL in a developing country. The results were comparable to those of the BFM 90 study and other contemporary groups and represented an increase in the cure rates in childhood B-NHL in Brazil.
Klumb
Claudete Esteves
CE
Serviço de Hematologia, Hospital do Câncer, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. cklumb@inca.gov.br
Schramm
Márcia Trindade
MT
De Resende
Lídia Maria Magalhães
LM
Carriço
Maria Kadma
MK
Coelho
Arthur Moellman
AM
de Meis
Ernesto
E
Ferreira
Regina Moreira
RM
Maia
Raquel Ciuvalschi
RC
Dobbin
Jane de Almeida
Jde A
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001215:Asparaginase / Q000009:adverse effects / Q000627:therapeutic use*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D003630:Daunorubicin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D009367:Neoplasm Staging; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D014750:Vincristine; D001215:Asparaginase; D011241:Prednisone; D003630:Daunorubicin