Early stage disease has a cure rate of 90 % and hence risk adapted combined modality treatment is the current standard of care. Modified nhlbfm 90 protocol for adolescents and young adults with burkitt lymphoma bl, mature bcell acute lymphoblastic leukemia ball and diffuse large bcell lymphoma dlbcl. Filipovich, helmut gadner, shinsaku imashuku, diane komp, stephan ladisch, david webb, and gritta janka, for the histiocyte. Therapy of advancedstage mature bcell lymphoma and. Modified bfm95 regimen as firstline chemotherapy in adults with t lymphoblastic lymphoma the safety and scientific validity of this study is. Nhl bfm 95 also had a reduction of asparaginase and doxorubicin in induction, which may have affected outcome, although this difference was not statistically significant. The improvement of treatment results in study nhlbfm 90 as compared with study nhlbfm 86 6 was exclusively due to a significant increase of pefs for patients with abdominal stage iii and ldh. Dr hansj6rg riehm who initiated the treatment strategy described in this.
Xia, xiao juan xiang, xiao qin chen, jia yu ling, lei zheng, wen biao luo, hui lin, you jian he, zhong zhen guan. Diagnosis and treatment of childhood nonhodgkin lymphoma. Clinical research performed within the allic bfm group but also. Modified bfm95 regimen as firstline chemotherapy in. Intensive chemotherapy for childhood acute lymphoblastic leukemia. Berlinfrankfurtmunich bfm protocols had been applied since 1995 bfmnhl 90, and since 1997 the bfmnhl95 protocol had been applied. During the last 15 years, children with nonhodgkin lymphomas nhl were treated according to the. Modified nhlbfm 90 protocol for adolescents and young adults. Over the course of the last three decades there has been significant improvement in the outcomes of children with nonhodgkin lymphoma nhl. Modified nhl bfm 90 protocol for adolescents and young adults with burkitt lymphoma bl, mature bcell acute lymphoblastic leukemia ball and diffuse large bcell lymphoma dlbcl. Second meeting of the subcommittee of the expert committee on the selection and use of essential medicines geneva, 29 september to 3 october 2008. All risk groups prednisolone po 60 mgm2 day 1 to 28 then taperover10 daysandcease methotrexate it 12 mg days 1, 12, 33.
Treatment intensity is stratified according to stages i and ii versus stages iii and iv. Results of the randomized intercontinental trial all icbfm 2002 jan stary, martin zimmermann, myriam campbell, luis castillo, eduardo dibar, svetlana donska. Treatment strategy in childhood bcell nhl the french experience. The united kingdom childrens cancer study group nhl. Longterm followup of primary intestinal aggressive. Tcell lbl tlbl accounts for nearly 90 % of all lbl cases and tends to occur in children and adolescents, predominantly in males. A prospective multicenter trial of combined immunochemotherapy for advancedstage bnhl with rituximab and the modified nhlbfm 90 protocol was conducted. Antineoplastic combined chemotherapy protocolsadverse effects. Autologous peripheral blood stem cell transplantation in.
Treatment results in childhood b nonhodgkin lymphoma with. Treatment protocol of the nhl bfm and the nopho study groups for mature aggressive bcell lymphoma and leukemia in children and adolescents b nhl 20 the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The number of our patients is too small and the followup of a. Intensive chemotherapy for childhood acute lymphoblastic. The major differences from the original protocol were a decrease in the dose of mtx from 5000 to mgm 2 24 h in the first 2 cht blocks. Non hodgkins lymphoma, may 1820, 2006, new york, ny.
Diffuse large bcell lymphoma relapsing in leukaemic. Begin this cycle 2 weeks after completing bfm mca consolidation and wbc 2. Efficacy of modified b nhl bfm 90 protocol on burkitts lymphoma in chinese children and adolescents. Rituximab in combination with bnhlbfm95 protocol was otherwise well tolerated and proved to be effective in children and adolescents with bnhl. Outcomes of modified nhlbfm 90 protocol for children and adolescents with lymphoblastic lymphoma. Therapy protocols designed to treat children with acute lymphoblastic. In spite of this success, a proportion of patients do not. Poor outcome for children and adolescents with progressive. The lmb protocols c patte, institut gustave roussy, france cesme, may 6th tpog meeting. Pet petct scans have an active role to play in reducing treatment for early stage disease. Bcell neoplasm with tailored intensification of therapy.
Nhl working group international protocol for the treatment of childhood anaplastic large cell lymphoma alcl 99 nhl 2000 06 study coordinator dr. This observation trial offers recommandations for the chemotherapy following the windowtrial. These guidelines are based on consensus among the experts and best available evidence applicable to indian setting. Update on burkitt lymphoma and leukemia hematology. The new study question for this group of patients is asked in the phaseiiwindowstudy bnhl bfm rituximab. The goal of the study was to offer all children and adolescents diagnosed with b. Therapy of bcell non hodgkins lymphoma nhl of childhood and adolescence. The new study protocol allic bfm 2009 is the final result of very comprehensive data analyses and discussions over the last few years. This recommandation is based on the published results of the trials bnhl bfm 90 and bbhl bfm 95 and fab lmb 96 for the treatment of cns.
Nhlbfm 90 therapy study in treatment of malignant nonhodgkins. The results of study nhlbfm 90 for alcl patients compare favorable with recently presented results from other study groups. In contrast with tlbl, tall is not as common as bcell all. Rituximab combined with autologous peripheral blood stem. Hodgkin lymphoma nhl, treated according to the nhl. Agerelated differences in the distribution, biology and treatment response of nonhodgkin s lymphoma nhl in adolescents remain to be elucidated.
Nonhodgkin lymphoma nhl in children and adolescents. The treatment results are approximately 10% lower than those reported by bfm investigators, but comparable to results from other centers. Late cardiotoxicity of highdose chemotherapy according. However, with the introduction of therapy protocol. The use of protocols based on bfm 90 study was feasible at this center. Request pdf modified nhlbfm 90 protocol for adolescents and young adults with burkitt lymphoma bl, mature bcell acute lymphoblastic leukemia. Patients are treatetd with a combination of intensive chemotherapy in combination with a radiation of the central nervous system stopped with the amendment of april 2010 and or haematopoietic stem cell. Shortpulse bnonhodgkin lymphomatype chemotherapy is.
The aim of this study was to evaluate the effect and safety of autologous peripheral blood stem cell transplantation apbsct in children and adolescents with non. Rituximab combined with autologous peripheral blood stem cell transplantation improve therapeutic effects of chemotherapy in pediatric patients with burkitts lymphoma. Treatment protocol of the nhlbfm and the nopho study groups for mature aggressive bcell lymphoma and leukemia in children and adolescents bnhl 20 the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Nhlbfm90 protocol was associated with a 5year eventfree survival efs estimate of 92% in more than 100 patients with lymphoblastic lymphomaa. Please destroy all previous drafts ukccsg data centre university of leicester dept. Ldh level was elevated in 21 72%, bulky disease 10 cm in 16 55% cases. Resumption of highdose methotrexate after methotrexate. Clinical research performed within the allic bfm group but also in parallel in the context of trial aieop bfm all 2000 produced. Reults of treatment with protocols bfm 90 and bfm 95. In the nhlbfm 90 protocol, all aa and bb courses include highdose methotrexate therapy, which consists of aggressive alkalinized hydration, methotrexate 5 gm.
The two children were treated according to bnhl bfm 90 protocol. The results of electrocardiography ecg and echocardiography echocg were analyzed in 40 dlbcl patients treated according to the mnhlbfm 90 program in the. Improved treatment results in childhood bcell neoplasms. The aim of this work is to establish which of the protocols, protocol bfm 90 or protocol bfm 95, have more influence in the treatment of the diseased children with lymphoblast leukemia. It was proposed that the major difference in efs between nhl bfm 90 and nhl bfm 95 resulted from the increased number of subsequent neoplasms observed in nhl bfm 95. Cd20 positive childhood bnon hodgkin lymphoma bnhl.
In the trials nhlbfm 90 and 95, patients with lbl stage iii to iv. Therefore, we have developed a hybrid petctguided protocol with intensive induction blocks a and b of rmnhlbfm904repoch without escalation. Although the patient was diagnosed as highgrade nhl infiltrating the bone marrow, strongly favouring dlbcl, she was started on rbfm 90 protocol, in view of the relapse with daepoch. Treatment results were not identical between nhl subtypes, with large cell lymphoma patients doing significantly better pefs 90 %, p. Subgroupdirected treatment protocols and achievements. Dramatic progress has been achieved, with survival rates exceeding 80%. Treatment of hemophagocytic lymphohistiocytosis with hlh. Children with stage iii are rare and achieve efs rates higher than 90 % with reducedintensity omission of reintensification in the bfm protocol and fulllength maintenance therapy. The purpose of our study was to investigate frequency and clinicopathological features of pbll in children and to test prospectively the efficacy of an all. Event free survival an overview sciencedirect topics. Irradiation was given to 5 patients 2 with bnhl, 3 with tnhl, and autologous stem cell transplantation was performed on 4 patients, all with bnhl 1 with central nervous system disease, 1 with residual. Nonhodgkin lymphoma remains an unpredictable condition in pediatric patients. The amlbfm 2004 trial is an multicenter doseoptimization trial for the treatment of acute myeloid leukeamias in children and adolescents. Prognostic relevance of genetic variations in tcell acute.
The patient attained complete remission of bone marrow post induction, but later, she died. Nonhodgkin lymphoma is the fourth most common malignancy in children, has an even higher incidence in adolescents, and is primarily represented by only a few histologic subtypes. To evaluate the late cardiotoxicity ct of highdose chemotherapy ct according to the modified nhlbfm 90 mnhlbfm 90 protocol in adult patients with diffuse large bcell lymphoma dlbcl. Treatment protocol of the nhlbfm and the nopho study. Even better, the survival rate at the age of 10 years in case of children diagnosed between 2005 and 2009 improved to 90. Case study subcutaneouspanniculitisliketcelllymphoma. Lbl is the second most common subtype of non hodgkins lymphoma nhl in children and adolescents, accounting for approximately 2% of all nhl cases. Nhlbfm95 also had a reduction of asparaginase and doxorubicin in induction, which may have affected outcome, although this difference was not statistically significant. The patient responded to the treatment and has remained asymptomatic for. Patients with lbl stage i to ii received identical treatment except. Hitherto poor outcomes, paucity of data and heterogeneity in international approach to pediatric nhl nonhodgkin lymphoma prompted the need for guidelines for indian population with vast variability in access, affordability and infrastructure across the country. In 16 patients with alcl alk was used nhlbfm 90 protocol common response co was achieved in 8 from 16 patients 50%, however 6 patients had disease progression and 3 had a relapse. Retrospective analysis was performed to assess the survival.