Outcome of childhood relapsed or refractory mature B-cell non-Hodgkin lymphoma and acute lymphoblastic leukemia

Abstract

Patients with childhood relapsed and refractory mature B-cell non-Hodgkin lymphoma (B-NHL) and acute lymphoblastic leukemia (B-ALL) are rare and have a dismal prognosis. The previous UK national analysis of 26 children over a 7-year period prior to 1996 had highlighted the poor outcome, with only three survivors. This 10-year multicenter study evaluated recent data, since 2000. Of 33 children, nine survived (27.3%), with a median follow-up of 4.3 years. On exclusion of six children treated with palliative intent, the survival was one-third (nine of 27; 33.3%). All patients with primary refractory disease (n = 7) and all except one with early relapse (n = 11) died. Administration of four doses of 375 mg/m² of rituximab was associated with a longer survival (p = 0.006). Response to reinduction (p < 0.001) and autologous hematopoietic stem cell transplant (auto-HSCT) (p = 0.003) were significant on multivariate analysis. Patients with a time to relapse of at least 6 months are potentially curable and must be offered intensive treatment with salvage chemotherapy, rituximab and auto-HSCT.

Keywords::

• Non-Hodgkin lymphoma
• childhood
• relapse
• survival

Acknowledgements

The authors wish to thank the following pediatric oncologists for providing data on relapsed patients: Veronica Neefjes (Aberdeen), Helen Rees (Bristol), Amos Burke (Cambridge), Owen Smith (Dublin), Hamish Wallace (Edinburgh), Johann Visser (Leicester), Rachael Hough (London), Bernadette Brennan (Manchester), Kevin Windebank (Newcastle), Martin Hewitt (Nottingham), Kate Wheeler (Oxford), Mary Gerrard (Sheffield) and Jan Kohler (Southampton).

Potential conflict of interest:

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The Childhood Cancer Research Group receives funding from the Department of Health, the National Cancer Intelligence Network, Children with Cancer UK and the Scottish Executive. The views expressed here are those of the authors and not necessarily of any of these organizations.