The Societe Francaise d'Oncologie Pediatrique LMB89 protocol: highly effective multiagent chemotherapy tailored to the tumor burden and initial response in 561 unselected children with B-cell lymphomas and L3 leukemia
| Autor: | Patrick Lutz, Guy Leverger, Anne Auperin, Didier Frappaz, Martine Raphael, Marie-Josée Terrier-Lacombe, Jean Michon, Yves Perel, Carole Coze, Henk Behrendt, Catherine Patte |
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| Přispěvatelé: | Faculteit der Geneeskunde |
| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty Vincristine Lymphoma B-Cell Adolescent Hydrocortisone Cyclophosphamide Immunology Leucovorin Biochemistry Gastroenterology Recurrence Internal medicine Acute lymphocytic leukemia Antineoplastic Combined Chemotherapy Protocols medicine Humans Child Survival rate Etoposide Neoplasm Staging business.industry Remission Induction Cytarabine Large-cell lymphoma Infant Cell Biology Hematology Precursor Cell Lymphoblastic Leukemia-Lymphoma Prognosis medicine.disease Chemotherapy regimen Confidence interval Lymphoma Surgery Survival Rate Methotrexate Doxorubicin Child Preschool Prednisone Female business medicine.drug |
| Zdroj: | Blood, 97(11), 3370-3379. American Society of Hematology |
| ISSN: | 1528-0020 0006-4971 |
| Popis: | This study was undertaken to show that a high survival rate can be obtained in B-cell (Burkitt and large B-cell) lymphoma and L3 leukemia with multiagent chemotherapy adapted to the tumor burden (stage, resection status, percentage of blasts in bone marrow, and central nervous system [CNS] involvement) and early response to chemotherapy, to investigate actual prognostic factors, and to see if large B-cell lymphoma can be treated with the same regimen as Burkitt lymphoma. Patients were classified into 3 risk groups. Group A (resected stage I and abdominal stage II) received 2 courses of vincristine, cyclophosphamide, doxorubicin, and prednisone. Group B (patients not eligible for groups A or C) received 5 courses of chemotherapy with, in addition, high-dose methotrexate, 3 g/m(2) over 3 hours; infusional cytarabine; and intrathecal (IT) methotrexate. Group C (patients with CNS involvement and acute lymphoblastic leukemia with at least 70% of blasts in bone marrow) received 8 courses with, in addition, high-dose methotrexate, 8 g/m(2); high-dose cytarabine; etoposide; and triple IT. Except in group A, treatment started with a prephase (COP, low-dose vincristine and cyclophosphamide). It was intensified for patients who did not respond to COP in group B and any patient with residual viable cells after the consolidation phase. A total of 561 patients were enrolled in the SFOP LMB89 protocol (July 1989-June 1996). Five-year survival is 92.5% (95% confidence interval [CI], 90%-94%) and event-free survival (EFS) 91% (95% CI, 89%-93%). EFS is 98% (95% CI, 90%-100%), 92% (95% CI, 89%-95%), and 84% (95% CI, 77%-90%) for group A, B, and C, respectively. In group B, multivariate analysis of prognostic factors showed that a lactate dehydrogenase level more than 2-fold the normal value, no response after COP, and age of at least 15 years were associated with a lower EFS. CNS involvement was the only prognostic factor in group C. (Blood. 2001;97:3370-3379) |
| Databáze: | OpenAIRE |
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