Results of Treatment of Advanced-Stage Lymphoblastic Lymphoma at St Jude Children’s Research Hospital From 1962 to 2002.

Results of treatment of advanced-stage lymphoblastic lymphoma at St Jude Children’s Research Hospital from 1962 to 2002.

Ann Oncol. 2013 Jun 20;
Sandlund JT, Pui CH, Zhou Y, Onciu M, Campana D, Hudson MM, Inaba H, Metzger ML, Bhojwani D, Ribeiro RC

Reliable prognostic factors have not been established for advanced-stage pediatric lymphoblastic lymphoma (LL). We analyzed treatment outcomes and potential risk factors in children and adolescents with advanced-stage LL treated over a 40-year period.From 1962 through 2002, 146 patients (99 boys and 47 girls) with stage III (n = 111) or stage IV (n = 35) LL were treated at St Jude Children’s Research Hospital. The five treatment eras were 1962-1975 (no protocol), 1975-1979 (NHL-75), 1979-1984 (Total 10 High), 1985-1992 (Pediatric Oncology Group protocol), and 1992-2002 (NHL13). Age at diagnosis was <10 years in 65 patients and ?10 years in 81.Outcomes improved markedly over successive treatment eras. NHL13 produced the highest 5-year event-free survival (EFS) estimate (82.9% ± 6.1% [SE]) compared with only 20.0% ± 8.0% during the earliest era. Treatment era (P < 0.0001) and age at diagnosis (<10 years versus ?10 years, P = 0.0153) were independent prognostic factors, whereas disease stage, lactate dehydrogenase level, and presence of a pleural effusion were not.Treatment era and age were the most important prognostic factors for children with advanced-stage LL. We suggest that a better assessment of early treatment response may help to identify patients with drug-resistant disease who require more intensive therapy. HubMed – drug



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