1. The Société Française d'Oncologie Pédiatrique 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.
- Author
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Patte C, Auperin A, Michon J, Behrendt H, Leverger G, Frappaz D, Lutz P, Coze C, Perel Y, Raphaël M, and Terrier-Lacombe MJ
- Subjects
- Adolescent, Antineoplastic Combined Chemotherapy Protocols adverse effects, Child, Child, Preschool, Cyclophosphamide adverse effects, Cytarabine adverse effects, Doxorubicin adverse effects, Etoposide adverse effects, Female, Humans, Hydrocortisone adverse effects, Infant, Leucovorin adverse effects, Lymphoma, B-Cell mortality, Lymphoma, B-Cell pathology, Male, Methotrexate adverse effects, Neoplasm Staging, Precursor Cell Lymphoblastic Leukemia-Lymphoma mortality, Precursor Cell Lymphoblastic Leukemia-Lymphoma pathology, Prednisone adverse effects, Prognosis, Recurrence, Remission Induction, Survival Rate, Vincristine adverse effects, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cyclophosphamide therapeutic use, Cytarabine therapeutic use, Doxorubicin therapeutic use, Etoposide therapeutic use, Hydrocortisone therapeutic use, Leucovorin therapeutic use, Lymphoma, B-Cell drug therapy, Methotrexate therapeutic use, Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy, Prednisone therapeutic use, Vincristine therapeutic use
- Abstract
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)
- Published
- 2001
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