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Br J Haematol. 2019 May 9. doi: 10.1111/bjh.15944. [Epub ahead of print]

Rituximab and reduced-intensity chemotherapy in children and adolescents with mature B-cell lymphoma: interim results for 231 patients enrolled in the second Russian-Belorussian multicentre study B-NHL-2010M.

Author information

1
Dmitri Rogachev National Research Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation.
2
Belorussian Research Centre for Paediatric Oncology, Haematology and Immunology, Minsk, Russian Federation.
3
Russian Children's Hospital, Moscow, Russian Federation.
4
City Clinical Hospital No. 31, St. Petersburg, Russian Federation.
5
Regional Children's Clinical Hospital No. 1, Ekaterinburg, Russian Federation.
6
Regional Children's Clinical Hospital, Arkhangelsk, Russian Federation.
7
Regional Children's Clinical Hospital, Krasnodar, Russian Federation.
8
Regional Children's Clinical Hospital, Perm, Russian Federation.
9
Regional Children's Clinical Hospital, Nizhny Novgorod, Russian Federation.
10
District Clinical Children's Hospital, Nizhnevartovsk, Russian Federation.

Abstract

The value of adding rituximab to chemotherapy in children with aggressive B-cell non-Hodgkin lymphoma (B-NHL) is still insufficiently studied. We enrolled 231 patients [mean age 9 years old (range 2-17); male:female ratio 3·4:1] with Burkitt (BL, 179 patients, 76·7%), diffuse large B-cell (32 patients, 14%), primary mediastinal B-cell (14 patients, 6%), and other (6 patients, 2·6%) B-cell lymphomas in a prospective study of immuno-chemotherapy. Stages were I-II in 32% and III-IV in 68% of the patients. Four doses of 375 mg/m2 rituximab were added to the Berlin-Frankfurt-Munster-NHL-90-like chemotherapy, with methotrexate being reduced or omitted in the first 2 induction blocks. The complete remission rate was 100% in limited-stage and 91·4% in advanced-stage patients. Five advanced-stage patients (2·2%) died in induction and 1 patient with stage 2 B-NHL died in remission; 11 patients in the high-risk group progressed on therapy (3 non-BL are alive after salvage) and 5 relapsed. Sixteen patients (9·7%) with advanced stage disease proceeded to transplant. With a median follow-up of 46 months, 98·5 ± 1% of patients with limited disease and 88·1 ± 2% (88·1% in Risk Group 3; 82·6% in Risk Group 4) in advanced stages are alive. This study confirmed that combined immunochemotherapy for B-lymphomas is highly effective in children, despite reducing the intensity of the induction blocks.

KEYWORDS:

chemotherapy; children; mature B-cell lymphoma; rituximab

PMID:
31069789
DOI:
10.1111/bjh.15944

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