OUTCOME AND TOXICITY PATTERNS IN CHILDREN AND ADOLESCENTS WITH NON-HODGKIN LYMPHOMA: A SINGLE INSTITUTION EXPERIENCE

Main Article Content

Paola Angelini *
Laura Rodriguez
Mohammed Zolaly
Ahmed Naqvi
Sheila Weitzman
oussama Abla
Angela Punnett
(*) Corresponding Author:
Paola Angelini | paola_angelini@yahoo.com

Abstract

Background: The incidence and biology of non-Hodgkin lymphoma (NHL) vary according to age. Some data suggest that the impact of age in pediatric and adolescent NHL patients depends on the histological subtype. Objectives: We aimed to analyze the impact of age at diagnosis on clinical characteristics and treatment-related toxicity in children and adolescents with NHL.

Methods: Retrospective review of medical records of children and adolescents diagnosed with NHL at the Hospital for Sick children, Toronto, between January 1995 and December 2008.

Results: 164 children were diagnosed with NHL during the study period, with a median age at diagnosis of 10 years. With a median follow-up of 6.2 years, 5-year OS in patients aged <15 and 15-18 years was 89± 2% vs 82% ± 6%, respectively (P = 0.30), and 5-year EFS was 84% ± 3% vs. 77% ± 7%  (P= 0.37). In Burkitts lymphoma (BL) and lymphoblastic lymphoma (LL) there was a trend towards better outcomes in children compared to adolescents, with EFS of  91% ± 4% vs. 75% ± 15%, respectively in BL (P= 0.17),  and 82% ± 7% vs. 51.4% ± 2% respectively in LL (P= 0.16). Late effects occurred in 21 patients (12.8%).

Conclusions: Children with NHL aged < 15 years tend to have better survival rates and less long-term toxicity than adolescents aged 15-18 years.


Downloads month by month

Downloads

Download data is not yet available.

Article Details

Author Biography

Paola Angelini, The Royal Marsden Hospital NHS Foundation Trust

Paediatric Oncology Consultant

Children and Young People Unit

References

REFERENCES
1. Bollard CM, Lim MS, Gross TG, Committee COGN-HL. Children's Oncology Group's 2013 blueprint for research: non-Hodgkin lymphoma. Pediatric blood & cancer. Jun 2013;60(6):979-984.
2. Mann G, Attarbaschi A, Burkhardt B, et al. Clinical characteristics and treatment outcome of infants with non-Hodgkin lymphoma. British journal of haematology. Nov 2007;139(3):443-449.
3. Patte C, Auperin A, Gerrard M, et al. Results of the randomized international FAB/LMB96 trial for intermediate risk B-cell non-Hodgkin lymphoma in children and adolescents: it is possible to reduce treatment for the early responding patients. Blood. Apr 1 2007;109(7):2773-2780.
4. Burkhardt B, Mueller S, Khanam T, Perkins SL. Current status and future directions of T-lymphoblastic lymphoma in children and adolescents. British journal of haematology. May 2016;173(4):545-559.
5. Han JY, Suh JK, Lee SW, Koh KN, Im HJ, Seo JJ. Clinical characteristics and treatment outcomes of children with anaplastic large cell lymphoma: a single center experience. Blood research. Dec 2014;49(4):246-252.
6. Burkhardt B, Oschlies I, Klapper W, et al. Non-Hodgkin's lymphoma in adolescents: experiences in 378 adolescent NHL patients treated according to pediatric NHL-BFM protocols. Leukemia. Jan 2011;25(1):153-160.
7. Burkhardt B, Zimmermann M, Oschlies I, et al. The impact of age and gender on biology, clinical features and treatment outcome of non-Hodgkin lymphoma in childhood and adolescence. British journal of haematology. Oct 2005;131(1):39-49.
8. Chan JK. The new World Health Organization classification of lymphomas: the past, the present and the future. Hematol Oncol. Dec 2001; 19(4):129-150.
9. Murphy SB, Fairclough DL, Hutchison RE, Berard CW. Non-Hodgkin's lymphomas of childhood: an analysis of the histology, staging, and response to treatment of 338 cases at a single institution. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Feb 1989;7(2):186-193.
10. Cairo MS, Gerrard M, Sposto R, et al. Results of a randomized international study of high-risk central nervous system B non-Hodgkin lymphoma and B acute lymphoblastic leukemia in children and adolescents. Blood. Apr 1 2007;109(7):2736-2743.
11. Brignole C, Marimpietri D, Pagnan G, et al. Neuroblastoma targeting by c-myb-selective antisense oligonucleotides entrapped in anti-GD2 immunoliposome: immune cell-mediated anti-tumor activities. Cancer letters. Oct 18 2005;228(1-2):181-186.
12. Cairo M, Pinkerton R. Childhood, adolescent and young adult non-Hodgkin lymphoma: state of the science. British Journal of Haematology. May 2016; 173(4):507-530
13. Manipadam MT, Nair S, Viswabandya A, Mathew L, Srivastava A, Chandy M. Non-Hodgkin lymphoma in childhood and adolescence: frequency and distribution of immunomorphological types from a tertiary care center in South India. World journal of pediatrics : WJP. Nov 2011;7(4):318-325.
14. Wright D, McKeever P, Carter R. Childhood non-Hodgkin lymphomas in the United Kingdom: findings from the UK Children's Cancer Study Group. Journal of clinical pathology. Feb 1997;50(2):128-134.
15. Hochberg J, Waxman IM, Kelly KM, Morris E, Cairo MS. Adolescent non-Hodgkin lymphoma and Hodgkin lymphoma: state of the science. British journal of haematology. Jan 2009;144(1):24-40.
16. Hwang IG, Yoo KH, Lee SH, et al. Clinicopathologic features and treatment outcomes in malignant lymphoma of pediatric and young adult patients in Korea: comparison of korean all-ages group and Western younger age group. Clinical lymphoma & myeloma. Nov 2007;7(9):580-586.
17. Patte C, Auperin A, Michon J, et al. 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. Blood. Jun 1 2001;97(11):3370-3379.
18. Cairo MS, Sposto R, Perkins SL, et al. Burkitt's and Burkitt-like lymphoma in children and adolescents: a review of the Children's Cancer Group experience. British journal of haematology. Feb 2003;120(4):660-670.
19. Cairo MS, Sposto R, Gerrard M, et al. Advanced stage, increased lactate dehydrogenase, and primary site, but not adolescent age (>/= 15 years), are associated with an increased risk of treatment failure in children and adolescents with mature B-cell non-Hodgkin's lymphoma: results of the FAB LMB 96 study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Feb 1 2012;30(4):387-393.
20. Mbulaiteye SM, Anderson WF, Ferlay J, et al. Pediatric, elderly, and emerging adult-onset peaks in Burkitt's lymphoma incidence diagnosed in four continents, excluding Africa. American journal of hematology. Jun 2012;87(6):573-578.
21. Trautman H, Hadzidimitriou A, Darzentas N et al. Evidence for antigen-driven development of molecularly classified Burkitt lymphomas. Blood. Nov 2009; 114(22):317.
22. Klapper W, Szczepanowski M, Burkhardt B, et al. Molecular profiling of pediatric mature B-cell lymphoma treated in population-based prospective clinical trials. Blood. Aug 15 2008;112(4):1374-1381.
23. Pillon M, Piglione M, Garaventa A, et al. Long-term results of AIEOP LNH-92 protocol for the treatment of pediatric lymphoblastic lymphoma: a report of the Italian Association of Pediatric Hematology and Oncology. Pediatric blood & cancer. Dec 2009;53(6):953-959.
24. Uyttebroeck A, Suciu S, Laureys G, et al. Treatment of childhood T-cell lymphoblastic lymphoma according to the strategy for acute lymphoblastic leukaemia, without radiotherapy: long term results of the EORTC CLG 58881 trial. European journal of cancer. Apr 2008;44(6):840-846.
25. Abromowitch M, Sposto R, Perkins S, et al. Shortened intensified multi-agent chemotherapy and non-cross resistant maintenance therapy for advanced lymphoblastic lymphoma in children and adolescents: report from the Children's Oncology Group. British journal of haematology. Oct 2008;143(2):261-267.
26. Termuhlen AM, Smith LM, Perkins SL, et al. Disseminated lymphoblastic lymphoma in children and adolescents: results of the COG A5971 trial: a report from the Children's Oncology Group. British journal of haematology. Sep 2013;162(6):792-801.
27. Tubergen DG, Krailo MD, Meadows AT, et al. Comparison of treatment regimens for pediatric lymphoblastic non-Hodgkin's lymphoma: a Childrens Cancer Group study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Jun 1995;13(6):1368-1376.
28. Le Deley MC, Reiter A, Williams D, et al. Prognostic factors in childhood anaplastic large cell lymphoma: results of a large European intergroup study. Blood. Feb 1 2008;111(3):1560-1566.
29. Williams DM, Hobson R, Imeson J, et al. Anaplastic large cell lymphoma in childhood: analysis of 72 patients treated on The United Kingdom Children's Cancer Study Group chemotherapy regimens. British journal of haematology. Jun 2002;117(4):812-820.
30. Brugieres L, Deley MC, Pacquement H, et al. CD30(+) anaplastic large-cell lymphoma in children: analysis of 82 patients enrolled in two consecutive studies of the French Society of Pediatric Oncology. Blood. Nov 15 1998;92(10):3591-3598.
31. Falini B, Pileri S, Zinzani PL, et al. ALK+ lymphoma: clinico-pathological findings and outcome. Blood. Apr 15 1999;93(8):2697-2706.
32. Shiota M, Nakamura S, Ichinohasama R, et al. Anaplastic large cell lymphomas expressing the novel chimeric protein p80NPM/ALK: a distinct clinicopathologic entity. Blood. Sep 1 1995;86(5):1954-1960.
33. Stein H, Foss HD, Durkop H, et al. CD30(+) anaplastic large cell lymphoma: a review of its histopathologic, genetic, and clinical features. Blood. Dec 1 2000;96(12):3681-3695.
34. von der Weid NX. Adult life after surviving lymphoma in childhood. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. Apr 2008;16(4):339-345.
35. Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood. May 12 2011;117(19):5019-5032.
36. Pillon M, Di Tullio MT, Garaventa A, et al. Long-term results of the first Italian Association of Pediatric Hematology and Oncology protocol for the treatment of pediatric B-cell non-Hodgkin lymphoma (AIEOP LNH92). Cancer. Jul 15 2004;101(2):385-394.
37. Woessmann W, Seidemann K, Mann G, et al. The impact of the methotrexate administration schedule and dose in the treatment of children and adolescents with B-cell neoplasms: a report of the BFM Group Study NHL-BFM95. Blood. Feb 1 2005;105(3):948-958.
38. Fujita N, Kobayashi R, Takimoto T, Nakagawa A, Ueda K, Horibe K. Results of the Japan Association of Childhood Leukemia Study (JACLS) NHL-98 protocol for the treatment of B-cell non-Hodgkin lymphoma and mature B-cell acute lymphoblastic leukemia in childhood. Leukemia & lymphoma. Feb 2011;52(2):223-229.
39. Sandlund JT, Pui CH, Zhou Y, et al. Effective treatment of advanced-stage childhood lymphoblastic lymphoma without prophylactic cranial irradiation: results of St Jude NHL13 study. Leukemia. Jun 2009;23(6):1127-1130.
40. Ducassou S, Ferlay C, Bergeron C, et al. Clinical presentation, evolution, and prognosis of precursor B-cell lymphoblastic lymphoma in trials LMT96, EORTC 58881, and EORTC 58951. British journal of haematology. Feb 2011;152(4):441-451.
41. Kobayashi R, Yamato K, Tanaka F, et al. Retrospective analysis of non-anaplastic peripheral T-cell lymphoma in pediatric patients in Japan. Pediatric blood & cancer. Feb 2010;54(2):212-215.
42. Windsor R, Stiller C, Webb D. Peripheral T-cell lymphoma in childhood: population-based experience in the United Kingdom over 20 years. Pediatric blood & cancer. Apr 2008;50(4):784-787.
43. Le Deley MC, Rosolen A, Williams DM, et al. Vinblastine in children and adolescents with high-risk anaplastic large-cell lymphoma: results of the randomized ALCL99-vinblastine trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Sep 1 2010;28(25):3987-3993.
44. Lowe EJ, Sposto R, Perkins SL, et al. Intensive chemotherapy for systemic anaplastic large cell lymphoma in children and adolescents: final results of Children's Cancer Group Study 5941. Pediatric blood & cancer. Mar 2009;52(3):335-339.
45. Wood WA, Lee SJ. Malignant hematologic diseases in adolescents and young adults. Blood. Jun 2 2011;117(22):5803-5815.