Relapses of childhood anaplastic large-cell lymphoma: Treatment results in a series of 41 children - a report from the French Society of Pediatric Oncology

• Published in: Annals of oncology Vol. 11; no. 1; pp. 53 - 58
• Main Authors: Brugières, L., Quartier, P., Le Deley, M.C., Pacquement, H., Perel, Y., Bergeron, C., Schmitt, C., Landmann, J., Patte, C., Terrier-Lacombe, M.J., Delsol, G., Hartmann, O.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.01.2000
• Subjects: ABMT; Adolescent; anaplastic large-cell lymphoma; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Asparaginase - administration & dosage; Biological and medical sciences; Bleomycin - administration & dosage; Bone Marrow Transplantation; Child; Child, Preschool; children; Cyclophosphamide - administration & dosage; Cytarabine - administration & dosage; Disease-Free Survival; Doxorubicin - administration & dosage; Female; Follow-Up Studies; France; Hematologic and hematopoietic diseases; Humans; Infant; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lomustine - administration & dosage; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - mortality; Lymphoma, Large B-Cell, Diffuse - pathology; Lymphoma, Large B-Cell, Diffuse - therapy; Male; Medical sciences; Methotrexate - administration & dosage; Prednisone - administration & dosage; Recurrence; relapse; Retrospective Studies; Survival Rate; Transplantation, Autologous; Transplantation, Homologous; vinblastine; Vinblastine - administration & dosage; Vincristine - administration & dosage; France; Human; Antineoplastic agent; Chemotherapy; Relapse; Treatment; Lymphoproliferative syndrome; Bone marrow; Graft; Malignant hemopathy; Large cell lymphoma; Non Hodgkin lymphoma; Child
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1023/A:1008352726155

Purpose: to study response to chemotherapy and the outcome of children treated for a relapsed anaplastic large-cell lymphoma (ALCL) and to evaluate the role of bone marrow transplantation (BMT) in these patients. Patients and methods: Clinical data concerning the 41 relapses that occurred in 119 patients with ALCL enrolled in 3 consecutive studies since 1975 were analysed. First-line treatment consisted of intensive chemotherapy according to the COPAD protocol for the first series of 12 patients treated between 1975 and 1989 and to the SFOP (French Society of Pediatric Oncology) HM protocols for the 30 patients treated between 1989 and 1997. Twenty-eight patients were treated with CV(B)A (CCNU, vinblastine, ara-C with or without bleomycin), and the others with miscellaneous protocols for recurrent disease. Fifteen patients underwent autologous BMT and 1 allogeneic BMT while in CR2. Results: Thirty-six of forty-one (88%) patients achieved CR2. With a median follow-up of 5 years, 12 patients died, 9 of their disease and 29 patients are alive in CR2 (20 patients), CR3 (5 patients), CR4 (2 patients), CR5 (1 patient) or CR6 (1 patient). Overall and disease-free survival are respectively 69% (53%–82%) and 44% (29%–61%) at three years. In univariate analysis, patients treated with ABMT while in CR2 did not appear to have a better outcome than the other. Remarkably, a long-lasting remission was obtained in 8 of 13 patients treated with weekly vinblastine for a relapse including 6 relapses occurring after ABMT. Conclusions: Relapsed ALCL are highly chemosensitive but over 40% of the patients experience several relapses. Prolonged conventional chemotherapy based on vinblastine might, in some cases, be as efficient as short intensive treatment with ABMT.