Treatment of a clinically determined lower-risk stage III non-lymphoblastic Non-Hodgkin lymphoma with less intensive therapy does not impact negatively on outcome
| Autor: | Asim F. Belgaumi, Lobna Shalaby, Rajeh Sabbah, Amani Al-Kofide, Christopher Alviedo, M. Ashraf Chaudhary |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Oncology
Male medicine.medical_specialty medicine.medical_treatment Disease Lower risk Disease-Free Survival Risk Factors Internal medicine Epidemiology Antineoplastic Combined Chemotherapy Protocols medicine Humans Prospective Studies Risk factor Stage (cooking) Cyclophosphamide Neoplasm Staging Limited Stage Chemotherapy business.industry Lymphoma Non-Hodgkin Hematology Surgery medicine.anatomical_structure Treatment Outcome Doxorubicin Vincristine Pediatrics Perinatology and Child Health Abdomen Prednisone Female business Follow-Up Studies |
| Zdroj: | Pediatric bloodcancer. 46(3) |
| ISSN: | 1545-5009 |
| Popis: | INTRODUCTIONOver three decades ago, it was realized that pediatricNHL as a group was a highly chemosensitive entity.Chemotherapeuticregimeshavesincebeendevelopedthathave resulted in an extremely good outcome for childrenwith this malignant disorder. Currently, with intensive,multi-agentchemotherapyprotocols,over90%ofpatientswith limited stage disease, and between 65% and 85%patientswithadvanceddisease,canexpecttobecured[1–3]. The wider range of cure rates seen for the advancedstage disease is a reflection of the differing response ofthe different histologic subtypes, and the overall poorerprognosis of patients with CNS disease.This high cure rate has been achieved by using time-anddose-intensivemulti-agenttreatmentprotocols.Treat-ment intensity is determined principally by the extent ofdisease. Other factors that have been associated with anincreased risk for relapse, and possibly requiring a moreintensive treatment regimen, are elevated lactate dehy-drogenase(LDH)levelsandahightumorcellproliferativeindex, for example as determined by Ki67expression [4–7]. Most of this treatment is administered in the inpatientsetting and, due to its intensity, results in significant acutetoxicity. Patients often require prolonged hospitalizationsas a result of these toxic complications.Staging systems for childhood Non-Hodgkins lym-phoma reflect tumor extent by focusing on the anatomicsites involved by the malignant process, and generallydo not incorporate the size of the tumor. For example,when using the St. Jude (Murphy) staging system [8],those patients categorized as stage III could have diseaseinvolving only the abdomen, or they could have general-izedextensive,lymphadenopathyextendingfromtheneckdown to the pelvis. Realizing this, several cooperativegroups involved in the treatment of pediatric NHL havecategorized their patients into treatment groups that maycross the stage boundaries. For example, the FrenchSociety of Pediatric Oncology (SFOP) has in their mostrecently completed LMB 96 study for NHL, subdividedtheirpatientsintotreatmentgroupsA,B,andC,ratherthanbase treatment assignment strictly on stage. Similarly, inthe BFM 90 study for Pediatric B-NHL and B-ALLpatients were stratified into three Risk Groups based on |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text