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Moleti ML, Al-Jadiry MF, Shateh WA, Al-Darraji AF, Mohamed S, Uccini S, Piciocchi A, Foà R, Testi AM, Al-Hadad S. Long-term results with the adapted LMB 96 protocol in children with B-cell non Hodgkin lymphoma treated in Iraq: comparison in two subsequent cohorts of patients. Leuk Lymphoma 2019; 60:1224-1233. [DOI: 10.1080/10428194.2018.1519810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Maria Luisa Moleti
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Mazin Faisal Al-Jadiry
- College of Medicine-Iraq, Department of Pediatrics, Children's Welfare Teaching Hospital-Baghdad, Baghdad, Iraq
| | | | | | - Sara Mohamed
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Stefania Uccini
- Department of Experimental Medicine/Pathology, Sapienza University of Rome, Rome, Italy
| | | | - Robin Foà
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Testi
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Salma Al-Hadad
- College of Medicine-Iraq, Department of Pediatrics, Children's Welfare Teaching Hospital-Baghdad, Baghdad, Iraq
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Pillon M, Mussolin L, Carraro E, Conter V, Aricò M, Vinti L, Garaventa A, Piglione M, Buffardi S, Sala A, Santoro N, Lo Nigro L, Mura R, Tondo A, Casale F, Farruggia P, Pierani P, Cesaro S, d'Amore ESG, Basso G. Detection of prognostic factors in children and adolescents with Burkitt and Diffuse Large B-Cell Lymphoma treated with the AIEOP LNH-97 protocol. Br J Haematol 2016; 175:467-475. [PMID: 27392319 DOI: 10.1111/bjh.14240] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/25/2016] [Indexed: 01/31/2023]
Abstract
Burkitt lymphoma (BL) and Diffuse Large B-Cell Lymphoma (DLBCL) account for most cases of non-Hodgkin lymphoma (NHL) in childhood. We report the clinical characteristics, outcome and prognostic factors in children with BL or DLBCL treated according to the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) LNH-97 protocol. Patients aged up to 18 years that were newly diagnosed with BL/DLBCL were included in the study. Therapy consisted of pre-phase followed by 2-6 high-dose chemotherapy courses tailored according to lactate dehydrogenase (LDH) value and disease stage. A total of 442 patients (379 BL, 63 DLBCL) were enrolled between 1997 and 2014, of whom 18 failed to achieve remission, 6 experienced treatment-related death, 2 developed second malignancy and 20 relapsed. At a median follow-up time of 5 years, overall survival was 93% (±1%) and event-free survival was 90% (±1%). LDH value above the median value had an independently negative prognostic value (P < 0·0001). However, in the subgroup of 128 patients in which minimal disseminated disease (MDD) was analysed, MDD-positivity became the only unfavourable prognostic factor for progression-free survival. Tailored chemotherapy could be extremely effective with limited toxicity. Identification of MDD as a hallmark of a higher risk of treatment failure may provide a target population for treatment intensification by anti-CD20.
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Affiliation(s)
- Marta Pillon
- Clinic of Paediatric Haemato-Oncology, Department of Women's and Children's Health, University of Padova, Padova, Italy.
| | - Lara Mussolin
- Clinic of Paediatric Haemato-Oncology, Department of Women's and Children's Health, University of Padova, Padova, Italy.,Institute of Paediatric Research - Fondazione Città della Speranza, Padova, Italy
| | - Elisa Carraro
- Clinic of Paediatric Haemato-Oncology, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Valentino Conter
- Department of Paediatrics, Ospedale San Gerardo, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Maurizio Aricò
- Medical Department, Paediatric Unit, Azienda Sanitaria Provinciale Ragusa, Ragusa, Italy
| | - Luciana Vinti
- Department of Paediatric Haemato-Oncology, IRCCS Ospedale Bambino Gesù, Roma, Italy
| | - Alberto Garaventa
- Department of Paediatric Haemato-Oncology, IRCCS I. G. Gaslini, Genova, Italy
| | - Matilde Piglione
- Department of Paediatric Haemato-Oncology, Regina Margherita Children's Hospital, Torino, Italy
| | - Salvatore Buffardi
- Department of Paediatric Haemato-Oncology, Santobono-Pausilipon Children's Hospital, Napoli, Italy
| | - Alessandra Sala
- Department of Paediatrics, Ospedale San Gerardo, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Nicola Santoro
- Department of Paediatric Haemato-Oncology, University of Bari, Bari, Italy
| | - Luca Lo Nigro
- Department of Paediatric Haemato-Oncology, Azienda Policlinico-OVE, Catania, Italy
| | - Rossella Mura
- Paediatric Haematology-Oncology, Ospedale Pediatrico Microcitemico, Cagliari, Italy
| | - Annalisa Tondo
- Department of Paediatric Haematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, Italy
| | - Fiorina Casale
- Department of Paediatric Haemato-Oncology, University of Napoli, Napoli, Italy
| | - Piero Farruggia
- Department of Paediatric Haemato-Oncology, ARNAS Ospedali Civico, G Di Cristina, Palermo, Italy
| | - Paolo Pierani
- Department of Paediatric Haemato-Oncology, Ancona, Italy
| | - Simone Cesaro
- Department of Paediatrics, Paediatric Haematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Giuseppe Basso
- Clinic of Paediatric Haemato-Oncology, Department of Women's and Children's Health, University of Padova, Padova, Italy
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Abdel Rahman H, Moussa E, Sedky M. Pediatric mature B-cell non Hodgkin lymphoma treatment with LMB-96 protocol. The Children Cancer Hospital Egypt experience. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.32.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ceppi F, Cazzaniga G, Colombini A, Biondi A, Conter V. Risk factors for relapse in childhood acute lymphoblastic leukemia: prediction and prevention. Expert Rev Hematol 2014; 8:57-70. [PMID: 25367188 DOI: 10.1586/17474086.2015.978281] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With current treatment regimens, survival rates for acute lymphoblastic leukemia (ALL) have improved dramatically since the 1980s, with current 5-year overall survival rates estimated at greater than 85%. This success was achieved, in part, through the implementation of risk-stratified therapy. Nevertheless, for a subgroup of patients (15-20%) with newly diagnosed ALL who will ultimately relapse, traditional risk assessment remains inadequate. The risk of relapse may be estimated on the basis of diagnostic features or early treatment response findings. Further progress in this field may thus come from refinement of predictive factors for relapse and treatment adaptation and from the identification of biological subsets of ALL patients who could benefit from specific target therapies. This article summarizes the aspects associated with the identification of predictive factors for relapse in childhood ALL and options available for prevention of disease recurrence.
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Affiliation(s)
- Francesco Ceppi
- Division of Haematology/Oncology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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De Souza MT, Hassan R, Liehr T, Marques-Salles TJ, Boulhosa AM, Abdelhay E, Ribeiro RC, Silva MLM. Conventional and molecular cytogenetic characterization of Burkitt lymphoma with bone marrow involvement in Brazilian children and adolescents. Pediatr Blood Cancer 2014; 61:1422-6. [PMID: 24668946 DOI: 10.1002/pbc.25030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 02/19/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Burkitt lymphoma/leukemia (BL/L) is cytogenetically characterized by the t(8;14)(q24;q32) or its variants, t(2;8)(p11;q21), and t(8;22)(q24;q11.2), which juxtapose the MYC oncogene to one of the three immunoglobulin loci. The overall cure rate of BL/L in children is 70-90%, but patients diagnosed with advanced-stage disease have a less favorable prognosis. It is possible that secondary chromosomal abnormalities contribute to this unfavorable prognosis via chemotherapy resistance, but the results of genetic studies have been inconsistent. This study aimed to identify and characterize secondary chromosomal abnormalities associated with the t(8;14) and its variants in children with French-American-British-L3 leukemia or Burkitt lymphoma with bone marrow involvement at the time of diagnosis. PROCEDURE Chromosome analysis was based on G-banding. Fluorescence in situ hybridization technique was applied using IGH/MYC/CEP8 dual-fusion and MYC break-apart probes. Multicolor chromosome banding was performed according to standard protocol. RESULTS We describe a group of BL/L with extreme adverse clinical outcome, in which secondary chromosomal abnormalities, particularly those involving the long arms of chromosomes 1 and 13, were found in 71% of cases. The IGH/MYC fusion showed molecular heterogeneity in 14% of cases and two cases exhibited three IGH/MYC fusion signals. CONCLUSIONS Secondary chromosomal abnormalities were found in a high proportion of patients. We observed an extent of IGH/MYC heterogeneity not previously reported in Burkitt lymphoma, including the novel finding of three fusion signals in two cases.
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Affiliation(s)
- Mariana T De Souza
- Post Graduation Program in Oncology, National Cancer Institute, Rio de Janeiro, RJ, Brazil; Cytogenetics Department, Bone Marrow Transplantation Unit, National Cancer Institute, Rio de Janeiro, RJ, Brazil; National Institute of Science and Technology for Cancer Control, Rio de Janeiro, Brazil
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Therapy of advanced-stage mature B-cell lymphoma and leukemia in children and adolescents with rituximab and reduced intensity induction chemotherapy (B-NHL 2004M protocol): the results of a multicenter study. J Pediatr Hematol Oncol 2014; 36:395-401. [PMID: 23823112 DOI: 10.1097/mph.0b013e31829d4900] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pediatric mature B-cell non-Hodgkin lymphomas (B-NHLs) are highly aggressive malignant tumors that are curable with chemotherapy (ChT). High-dose methotrexate (MTX) is considered indispensable for successful treatment, but this therapy frequently induces severe mucositis and infectious complications, especially in induction, which can cause treatment failure. A prospective multicenter trial of combined immunochemotherapy for advanced-stage B-NHL with rituximab and the modified NHL-BFM-90 protocol was conducted. The major differences from the original protocol were a decrease in the dose of MTX from 5000 to 1000 mg/m/24 h in the first 2 ChT blocks and the addition of rituximab at 375 mg/m to each of the first 4 blocks of ChT. Eighty-three newly diagnosed patients with a median age of 8.84 years with Burkitt lymphoma/leukemia and diffuse large B-cell lymphomas stage III to IV were included. Four patients died during induction ChT due to tumor lysis syndrome and infection. Two additional patients died subsequently due to tumor resistance. Complete remission was achieved in 77 (92.8%) patients; 2 patients relapsed at 1 and 3 months, and 2 developed secondary malignancies at 1 and 6.5 years, respectively, after the completion of therapy. The overall survival probability was 82%±8% with a median follow-up of 65.2 months. Combined therapy with rituximab and intensive ChT with a reduced MTX dose of 1 g/m in the 2 induction courses was feasible and produced high cure rates in patients with pediatric advanced-stage mature B-NHL.
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Relationship of Epstein-Barr virus and interleukin 10 promoter polymorphisms with the risk and clinical outcome of childhood Burkitt lymphoma. PLoS One 2012; 7:e46005. [PMID: 23029361 PMCID: PMC3459931 DOI: 10.1371/journal.pone.0046005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 08/27/2012] [Indexed: 01/12/2023] Open
Abstract
Epstein-Barr virus (EBV) is an important environmental factor associated to the development of Burkitt lymphoma (BL) in endemic and intermediate risk regions. However, little is known about the contribution of genetic constitution to the development and clinical response of the disease. The aim of this work was to investigate the role of EBV and Interleukin 10 (IL10) single nucleotide polymorphisms (-1082A/G, -819C/T, -592C/A) and microsatellites (IL10.R and IL10.G) in susceptibility and clinical outcome in pediatric BL patients, in a region with intermediate EBV association frequency. The frequencies of IL10 promoter Single nucleotide polymorphisms -1082A/G, -819C/T, -592C/A, and IL10.R and IL10.G microsatellites were compared in 62 pediatric patients and 216 healthy donors. IL10 -1082GG and GCC/GCC genotypes were more frequent in patients than in controls, and associated to a higher risk of BL development (GG genotype OR 2.62, 95% CI, 1.25-5.51; P = 0.008; Pc = 0.024). EBV was detected in tumor samples by EBER-ISH in 54.1% of cases. EBV+ patients exhibited a better event free survival (EFS) (P = 0.019) than EBV- patients. Carriers of IL10 R3-GCC had worse EFS (P = 0.028). Our results suggest a risk effect and an independent prognostic value of IL10 polymorphisms and EBV in childhood BL patients.
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Casanova M, Medina-Pérez A, Moreno-Beltran M, Mata-Vazquez M, Rueda A. Critical appraisal of pralatrexate in the management of difficult-to-treat peripheral T cell lymphoma. Ther Clin Risk Manag 2011; 7:401-8. [PMID: 22076116 PMCID: PMC3208406 DOI: 10.2147/tcrm.s22834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aggressive T cell lymphomas are a subgroup of lymphomas with a particularly poor prognosis. This is especially true for patients with recurrent or refractory disease, who typically have limited response to salvage therapy and extremely poor overall survival. For this reason, there is a strong need to develop potentially active drugs for these malignancies. Pralatrexate is a novel antifolate designed to have high affinity for reduced folate carrier type 1. Preclinical and clinical studies have demonstrated that pralatrexate has significant activity against T cell lymphomas. The dose-limiting toxicity for pralatrexate is mucositis, which can be abrogated with folic acid and vitamin B12 supplementation. Pralatrexate is the first single agent approved for the treatment of patients with relapsed or refractory peripheral T cell lymphoma. This approval was based on an overall objective response rate observed in the pivotal study. The overall response rate was 29%, with a median duration of 10.1 months. This article reviews the biochemistry, preclinical experience, metabolism, and pharmacokinetics of pralatrexate, including the clinical experience with this agent in lymphoma. Future areas of development are now focused on identifying synergistic combinations of pralatrexate with other agents and the evaluation of predictive markers for clinical benefit.
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Affiliation(s)
- M Casanova
- Oncohematology Service, Hospital Costa del Sol, Marbella, Spain
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Role of peroxisome proliferator-activated receptor gamma and its ligands in the treatment of hematological malignancies. PPAR Res 2011; 2008:834612. [PMID: 18528522 PMCID: PMC2408681 DOI: 10.1155/2008/834612] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 04/21/2008] [Indexed: 02/07/2023] Open
Abstract
Peroxisome proliferator-activated receptor gamma (PPARgamma) is a multifunctional transcription factor with important regulatory roles in inflammation, cellular growth, differentiation, and apoptosis. PPARgamma is expressed in a variety of immune cells as well as in numerous leukemias and lymphomas. Here, we review recent studies that provide new insights into the mechanisms by which PPARgamma ligands influence hematological malignant cell growth, differentiation, and survival. Understanding the diverse properties of PPARgamma ligands is crucial for the development of new therapeutic approaches for hematological malignancies.
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Cho B. The next step for Burkitt lymphoma. THE KOREAN JOURNAL OF HEMATOLOGY 2011; 46:60-1. [PMID: 21747873 PMCID: PMC3128899 DOI: 10.5045/kjh.2011.46.2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Bin Cho
- Department of Pediatrics, The Catholic University of Korea, School of Medicine, Seoul, Korea
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Moleti ML, Al-Hadad SA, Al-Jadiry MF, Al-Darraji AF, Al-Saeed RM, De Vellis A, Piciocchi A, Uccini S, Foà R, Testi AM. Treatment of children with B-cell non-Hodgkin lymphoma in a low-income country. Pediatr Blood Cancer 2011; 56:560-7. [PMID: 21298740 DOI: 10.1002/pbc.22905] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 10/08/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND An adapted LMB 96 derived protocol for B-cell non-Hodgkin lymphoma (NHL) was implemented at the pediatric oncology unit of the Children Welfare Teaching Hospital in Baghdad (Iraq) from 2000 to present. The purpose was to evaluate the feasibility and efficacy of this intensive therapeutic regimen in a limited resource country. METHODS Patients <15 years of age with high grade B-cell NHL were included. A modified LMB 96 regimen was employed with a reduction of cyclophosphamide and methotrexate dosages due to inadequate laboratory facilities and supportive care. RESULTS Between 2000 and 2005, 261 children with non-lymphoblastic NHL were registered; 239 were eligible for the analysis. Two patients had stage I disease, 20 stage II, 179 stage III, and 38 stage IV. Fifty-two patients (22%) had bulky disease. Twelve children were assigned to therapeutic group A (low risk), 184 to group B (intermediate risk), and 43 to group C (high risk). One hundred and eighty-four patients (77%) had a complete response after the COP pre-phase. Sixty-nine patients (29%) died during treatment. Twenty-nine patients abandoned treatment. At 24 months, the overall survival rate of the entire patient population was 66% (CI 95%: 62.2-70.6) and the event-free survival rate 53.3% (CI 95%: 50.0-56.8). CONCLUSIONS The treatment schedule proved effective, but the treatment-related mortality due to infections and metabolic complications was very high owing to the limited supportive care available. The high rate of treatment abandonment was also an important cause of failure, especially for children living far away from the hospital.
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Affiliation(s)
- Maria Luisa Moleti
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
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Pillon M, Aricò M, Basso G, Locatelli F, Citterio M, Micalizzi C, Testi AM, Barisone E, Nardi M, Lombardi A, Rondelli R, Rosolen A. Long-term results of AIEOP-8805 protocol for acute B-cell lymphoblastic leukemia of childhood. Pediatr Blood Cancer 2011; 56:544-50. [PMID: 21298738 DOI: 10.1002/pbc.22787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 07/16/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute B-cell leukemia (B-ALL) is a rare form of pediatric leukemia characterized by a very high-proliferation index, rapid clinical progression, and a high frequency of central nervous system (CNS) involvement. Commonly, it is treated in the clinical trials for Burkitt lymphoma, of which it represents the leukemic counterpart. PROCEDURE Children with B-ALL diagnosed between 1988 and 1999 were enrolled in the AIEOP-8805 protocol. Treatment included six high-dose chemotherapy courses. No prophylactic CNS irradiation was administered. RESULTS Sixty-five consecutive patients were enrolled in the study. L3 morphology was observed in 57 of 65 patients (88%). Twenty-five children (38%) had tumor mass in addition to massive bone marrow infiltration; 11 children (17%) had CNS disease at diagnosis. Sixty-two patients obtained complete morphological remission of which 13 suffered a relapse, including 3 with initial CNS involvement. Ten-year overall survival and event-free survival were 77% and 75%, respectively. Neither relevant long-term toxicity nor second malignancies were observed. CONCLUSIONS The AIEOP-8805 confirmed that short high-dose chemotherapy is highly effective for the treatment of B-ALL without significant long-term adverse sequelae. Therapy modifications to reduce relapse rate, such as the use of anti-CD20 monoclonal antibody and more effective CNS treatment, are being tested.
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Affiliation(s)
- Marta Pillon
- Pediatric Onco-Hematology Unit, University Hospital of Padova, Padova, Italy
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de Souza MT, Mkrtchyan H, Hassan R, Ney-Garcia DR, de Azevedo AMB, da Costa ES, de Figueiredo AF, Liehr T, Abdelhay E, Silva MLM. Secondary abnormalities involving 1q or 13q and poor outcome in high stage Burkitt leukemia/lymphoma cases with 8q24 rearrangement at diagnosis. Int J Hematol 2011; 93:232-236. [DOI: 10.1007/s12185-010-0757-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 11/24/2010] [Accepted: 12/15/2010] [Indexed: 11/28/2022]
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de Jong D. Novel lymphoid neoplasms--the borderland between diffuse large B-cell lymphoma and Burkitt's lymphoma. Haematologica 2009; 94:894-6. [PMID: 19570750 DOI: 10.3324/haematol.2009.008128] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Rueda A, Casanova M, Quero C, Medina-Pérez A. Pralatrexate, a new hope for aggressive T-cell lymphomas? Clin Transl Oncol 2009; 11:215-20. [PMID: 19380298 DOI: 10.1007/s12094-009-0343-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aggressive T-cell lymphomas represent a particularly poor-prognosis subgroup of lymphomas. This is especially true for patients with recurrent or refractory disease who typically have a limited response to salvage therapy and an extremely poor overall survival. There is thus a strong need to develop potentially active drugs for these malignancies. Pralatrexate is a novel antifolate designed to have high affinity for the reduced folate carrier type 1. Preclinical and clinical studies have demonstrated that pralatrexate has significant activity against T-cell lymphomas.The dose-limiting toxicity for pralatrexate is mucositis,which could be abrogated with folic acid and vitamin B12 supplementation. Pralatrexate is now being evaluated in phase II clinical trials for the treatment of peripheral T-cell lymphoma, and in a phase I/II trial in combination with gemcitabine for the treatment of non-Hodgkin's lymphoma. Because of the limited therapies available for aggressive T-cell lymphoma, pralatrexate could secure a niche for the treatment of this condition, provided on going clinical trials and future phase III trials confirm the efficacy of the drug.
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Affiliation(s)
- Antonio Rueda
- Servicio de Oncohematología, Hospital Costa del Sol, Autovía A-7, Km 187, Marbella, Málaga, Spain.
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Dembowska-Baginska B, Perek D, Brozyna A, Wakulinska A, Olczak-Kowalczyk D, Gladkowska-Dura M, Grajkowska W, Chrzanowska KH. Non-Hodgkin lymphoma (NHL) in children with Nijmegen Breakage syndrome (NBS). Pediatr Blood Cancer 2009; 52:186-90. [PMID: 18937313 DOI: 10.1002/pbc.21789] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Due to small number of patients with Nijmegen Breakage Syndrome (NBS) and Non-Hodgkin lymphoma (NHL) experience in their treatment is limited. PROCEDURE Since 1996, 17 patients with a median age of 9.5 years who had NBS, were treated for NHL. NHL type, stage, chemotherapy, dose modifications, chemotherapy delays, response to chemotherapy, toxicity, outcome and correlation of drug reduction with response to treatment and outcome were analyzed. RESULTS Nine patients had TNHL, eight BNHL. TNHL patients received BFM and BNHL LMB type protocols. Doses of cytostatics were reduced in the first chemotherapy courses. Further modifications depended on severity of complications. None of the patients complied with timing of chemotherapy. Complete remissions after induction were achieved in 8 of 9 TNHL and 3 out 8 of BNHL patients. All patients experienced grade 4 toxicities. Two patients died from complications. Six of 17 patients are alive. All received more than 80% of recommended doses of chemotherapy. No differences in the type, number of responses or grade 3 and 4 toxicities between patients receiving less or more than 80% of drug doses were observed. Treatment related deaths concerned patients who received less than 80% of drug doses. CONCLUSIONS Patients with NBS develop both T and B cell lymphomas. Treatment outcome is poor and might be improved by administering over 80% of drug doses. Although toxicity often depends upon drug doses, our patients experienced equal grade 3 and 4 toxicities whether they received more or less than 80% of the chemotherapeutic agents.
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Abstract
Lymphomas are the third most common cancer in children and Burkitt lymphoma (BL) accounts for about 40% of them. The rectum is extremely seldom involved in BL: 91 children were treated at our institution for BL between 1987 and June 2006, but none of them had involved the rectum. We report here on a 9-year-old boy who presented with bowel bleeding and subocclusion, which proved due to a BL of the rectum. The role of surgery for this tumor is limited nowadays, except for surgical emergencies, biopsies, and second-look surgery in selected cases.
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Moleti ML, Testi AM, Giona F, Malandruccolo L, Pescarmona E, Martino P, Paoloni F, Barberi W, Palumbo G, Mandelli F, Foa R. CODOX-M/IVAC (NCI 89-C-41) in children and adolescents with Burkitt's leukemia/lymphoma and large B-cell lymphomas: a 15-year monocentric experience. Leuk Lymphoma 2007; 48:551-9. [PMID: 17454598 DOI: 10.1080/10428190601078944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
During the last 15 years, we have used the National Cancer Institute (NCI) 89-C-41 protocol in patients aged younger than 21 years with Burkitt's leukemia/lymphoma (BLL) and diffuse large B-cell lymphoma (DLBCL). According to the Magrath staging system, patients were classified as low and high risk. Low-risk received three cycles of the CODOX-M regimen; high-risk patients received four alternating cycles with the CODOX-M and IVAC regimens. Thirty-five patients entered the study: 32 (91%) achieved complete remission (CR); three were non-responders and died and one patient died in CR. Two responders relapsed after 2 months and one presented early B acute lymphoblastic leukemia 33 months from the end of therapy. The 5-year overall survival and event free-survival are 83% and 80%, respectively. No late toxicity was registered. In our experience with a median follow-up of 11 years, the NCI 89-C-41 protocol has confirmed its high cure rate in BLL and DLBCL children and adolescents.
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Affiliation(s)
- Maria Luisa Moleti
- Division of Haematology, Department of Cellular Biotechnologies, University La Sapienza, Rome, Italy.
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Onciu M, Schlette E, Zhou Y, Raimondi SC, Giles FJ, Kantarjian HM, Medeiros LJ, Ribeiro RC, Pui CH, Sandlund JT. Secondary chromosomal abnormalities predict outcome in pediatric and adult high-stage Burkitt lymphoma. Cancer 2006; 107:1084-92. [PMID: 16862570 DOI: 10.1002/cncr.22089] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Karyotypic abnormalities in sporadic Burkitt lymphoma (BL) have been described extensively. However, to the authors' knowledge, very limited studies have focused on the secondary chromosomal abnormalities in pediatric BL as compared with those of adult BL and on their prognostic impact. METHODS A retrospective analysis was performed in all pediatric and adult patients at 2 institutions, with a morphologic diagnosis of BL, pretherapy tumor karyotype available, and t(8;14), t(8;22), or t(2;8) present. RESULTS There were 33 children and 37 adults. The majority of the patients (95%) had Stage III/IV disease. There were no statistically significant differences noted in karyotype complexity and the nature of the chromosomal abnormalities between these 2 groups. Abnormalities of chromosomes 13 (13q) and 22 (22q) had a negative impact on prognosis in children. In adults, abnormalities of chromosome 17 appeared to have a negative impact. CONCLUSIONS The current findings suggest that karyotypic information can be used for refining risk stratification in patients with BL.
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Affiliation(s)
- Mihaela Onciu
- Department of Pathology, St. Jude Children's Hospital, Memphis, Tennessee 38105, USA
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20
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Frache S, Peter MO, Laithier V, Bertrand AM, Thiriez G, Menget A, Kantelip B, Yakouben K, Plouvier E, Rohrlich PS. [Involvement of thyroid gland at non-Hodgkin lymphoma initial diagnosis: 2 pediatric cases]. Arch Pediatr 2005; 13:38-40. [PMID: 16271453 DOI: 10.1016/j.arcped.2005.09.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Accepted: 09/27/2005] [Indexed: 10/25/2022]
Abstract
Extranodal thyroid lymphomatous involvement is rare in childhood. We report here 2 children, 1 with vertical transmission-acquired human immunodeficiency virus (HIV), presenting with lymphomatous infiltration of the thyroid gland at diagnosis. One child had infra-clinical endocrine impairment and both responded well to chemotherapy. Although the cases are too scarce to be affirmative, thyroid gland involvement doesn't seem to alter the good prognosis of childhood Burkitt's lymphoma. The third child's cancer in frequency is Non-Hodgkin Lymphomas. Presenting as the initial AIDS event in 1 patient, this case report also highlights the need to systematically propose antiretroviral therapy in vertically HIV infected children.
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Affiliation(s)
- S Frache
- Service d'oncohématologie pédiatrique, CHU de Besançon, La Mère et l'Enfant, 2, place Saint-Jacques, 25030 Besançon, France.
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21
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Laver JH, Kraveka JM, Hutchison RE, Chang M, Kepner J, Schwenn M, Tarbell N, Desai S, Weitzman S, Weinstein HJ, Murphy SB. Advanced-stage large-cell lymphoma in children and adolescents: results of a randomized trial incorporating intermediate-dose methotrexate and high-dose cytarabine in the maintenance phase of the APO regimen: a Pediatric Oncology Group phase III trial. J Clin Oncol 2005; 23:541-7. [PMID: 15659500 DOI: 10.1200/jco.2005.11.075] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Pediatric Oncology Group adopted a histology-based approach to non-Hodgkin's lymphoma and treated patients with advanced large-cell lymphoma on a separate protocol (doxorubicin, vincristine, prednisone, 6-mercaptopurin, and methotrexate; APO regimen). In this study, we assessed the effects of an intense antimetabolite therapy alternating with APO on overall survival (OS) and event-free survival (EFS) and looked into biologic correlates. PATIENTS AND METHODS From December 1994 to April 2000, we enrolled 180 eligible pediatric patients with stage III/IV large-cell lymphoma (LCL); 90 patients were randomly assigned to the intermediate-dose methotrexate (IDM) and high-dose cytarabine (HiDAC) arm, 85 patients to the APO arm, and five patients directly to the APO arm by study design due to CNS involvement. Planned therapy duration was 12 months. RESULTS The 4-year EFS for all patients was 67.4% (SE, 4.2%), and OS was 80.1% (SE, 3.6%) without any significant difference between the two arms. The 4-year EFS and OS were 71.8% (SE, 6.1%) and 88.1% (SE, 4.4%), respectively, for patients with anaplastic large-cell lymphoma, and 63.8% (SE, 10.3%) and 70.3% (SE, 9.0%), respectively, for patients with diffuse large B-cell lymphoma. Only 11 patients required radiation (due to unresponsive bulky disease or CNS involvement). The IDM/HiDAC arm was associated with more toxicity. CONCLUSION The efficacy of incorporating IDM/HiDAC in the treatment plan of pediatric and adolescent patients with advanced-stage LCL was inconclusive as to its effect on EFS, regardless of the lymphoma phenotype. It cannot be excluded that with a higher number of patients, one treatment could prove superior and future studies will build on these data.
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Affiliation(s)
- Joseph H Laver
- Department of Pediatrics, Medical College of Virginia, PO Box 980646, Richmond, VA 23298-0646, USA.
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Boerma EG, van Imhoff GW, Appel IM, Veeger NJGM, Kluin PM, Kluin-Nelemans JC. Gender and age-related differences in Burkitt lymphoma--epidemiological and clinical data from The Netherlands. Eur J Cancer 2005; 40:2781-7. [PMID: 15571961 DOI: 10.1016/j.ejca.2004.09.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Revised: 07/27/2004] [Accepted: 09/03/2004] [Indexed: 11/21/2022]
Abstract
Although Burkitt's lymphoma (BL) is classified as one entity in the World Health Organisation (WHO) classification, we wondered whether BL should not be considered as a different disease in children compared with adults. Netherlands Cancer Registry (NCR) data were obtained from 1994 to 1998 (n=203). Detailed clinical data from two treatment protocols were compared: one for adults up to the age of 65 years (n=27) and one for children (n=80). All slides of the two clinical studies were centrally reviewed which included immunophenotyping and when necessary breakpoint analysis of MYC/8q24. Only cases with an unambiguous diagnosis of BL (classical and atypical BL) were accepted. The age distribution of BL-patients showed a bimodal distribution with a peak at the paediatric age and a steady increase after approximately 60 years of age. Most of the patients were males (89% for children and 78% for adults) and only male patients showed this bimodality. Children more often had extranodal disease (81% vs. 59%), whereas adults more often had nodal disease (89% vs. 53%). Based on epidemiology and clinical presentation, the concept that BL is one disease should be re-challenged.
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Affiliation(s)
- E G Boerma
- Department of Haematology, Groningen University Medical Centre, The Netherlands.
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Wessels G, Bernard Hesseling P. Perspectives of the management of childhood lymphoma: experience at Tygerberg Hospital, Western Cape, South Africa. Transfus Apher Sci 2005; 32:27-31. [PMID: 15737871 DOI: 10.1016/j.transci.2004.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 10/01/2004] [Indexed: 10/25/2022]
Abstract
Hodgkin's disease (HD) in children corresponds to a large degree to HD in adults. Non-Hodgkin's Lymphoma (NHL) in children, however, differs from NHL in adults with respect to the classification, natural history, management and course. For practical reasons clinicians generally classify and treat NHL in children as either B-cell or T-cell disease. Over the past 22 years, the Paediatric Oncology Unit of the Tygerberg Hospital has treated HD with three different regimens. Use of the CLVPP and MOPP/ABVD regimens resulted in late relapses that adversely affected event free survival (EFS). For the last four years HD has been treated according to the regimen suggested by Schellong with good short term survival rates. Lymphoblastic or T-cell NHL is treated with regimens normally used for acute lymphoblastic leukaemia (e.g. BFM protocols) or modified leukaemia treatments for leukaemia-lymphoma syndromes (e.g. LSA2L2). We lately use a modified BFM regimen with a 70% EFS for all stages. Three consecutive regimens have been used to treat B-cell NHL over the past 22 years. The first was a COMP regimen, followed by the LMB-89 and LMB-96 regimens. Although toxicity has increased with the increased intensity of the treatment regimen, EFS has improved from 25% to 87% for all B-cell NHL. The majority of patients had stage III and IV disease. Although the LMB regimens are toxic, the implementation is manageable provided good laboratory back up and supportive facilities are available.
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Affiliation(s)
- Glynn Wessels
- Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, P.O. Box 19063, Tygerberg 7505, South Africa.
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Klumb CE, Schramm MT, De Resende LMM, Carriço MK, Coelho AM, de Meis E, Ferreira RM, Maia RC, Dobbin JDA. Treatment of children with B-cell non-Hodgkin's lymphoma in developing countries: the experience of a single center in Brazil. J Pediatr Hematol Oncol 2004; 26:462-8. [PMID: 15218425 DOI: 10.1097/00043426-200407000-00014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To treat non-Hodgkin's B-cell lymphoma (B-NHL) in children with manageable toxicity-related morbidity and without any decrease in survival. PATIENTS AND 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.
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Affiliation(s)
- Claudete Esteves Klumb
- Serviço de Hematologia, Hospital do Câncer, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
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Recent publications in hematological oncology. Hematol Oncol 2003; 21:141-8. [PMID: 14594017 DOI: 10.1002/hon.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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