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Treatment of Childhood T‐Cell Lymphoblastic Lymphoma—Long‐Term Results of the SFOP LMT96 Trial
Author(s) -
Bergeron Christophe,
Coze Carole,
Segura Céline,
Pacquement Hélène,
Gandemer Virginie,
Ducassou Stéphane,
Patte Catherine
Publication year - 2015
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25699
Subject(s) - medicine , lymphoblastic lymphoma , mucositis , neutropenia , methotrexate , chemotherapy , cyclophosphamide , lymphoma , vincristine , pediatric oncology , pediatrics , surgery , cancer , immunology , t cell , immune system
Purpose Outcome of T‐cell lymphoblastic lymphoma (T‐LBL) in children is around 75–85% of event‐free survival. The role of early intensification to improve outcome while using short infusions of high dose methotrexate (HDMTX) and shorter maintenance treatment was addressed by the French Society of Pediatric Oncology (SFOP) group. Methods From 1997 through 2003, 79 children (52 males; median age 10.5 years) were prospectively registered into the SFOP LMT 96 trial. The LMT96 protocol, with elements from the protocol of the Berlin‐Frankfurt‐Münster (BFM) Group included four main modifications: (a) 10 courses of HD‐MTX (3 g/m 2 ) delivered over the first 44 weeks; (b) early intensification with cyclophosphamide together with the first course of HD‐MTX; (c) a maintenance phase that included 6 monthly intensified chemotherapy pulses; and (d) treatment duration of 18 months for stages I–III. Results Eighty‐nine percent of patients had an initial mediastinal involvement. With a median follow‐up of 87 months, the 5‐year event‐free survival was 85% and overall survival 89%. Nine patients relapsed, eight during treatment. The early intensification did not change the pattern of relapses. Only 58% of patients experienced grade 3–4 neutropenia during the induction phase, 13% patients experienced grade 3 and 4 mucositis, and 5% patients experienced diabetes. The early intensification did not delay phases of chemotherapy. Conclusions Early intensification in treatment for T‐LBL in children is manageable. Three‐hour infusion of HD‐MTX did not jeopardize patient outcome. Our results are comparable with those of other international protocols in spite of shorter maintenance treatment for stages I–III. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.