1. Clinical outcomes and Prognostic factors in children with B-Lymphoblastic Lymphoma (pB-LBL) treated on Modified BFM-90 protocol: experience from a tertiary cancer care center in India
- Author
-
Sneha Shah, Epari Sridhar, Chetan Dhamne, Maya Prasad, Siddhartha Laskar, Seema Kembhavi, S D Banavali, Nirmalya Roy Moulik, Kalasekhar Vijayasekharan, Sumeet Gujral, Gaurav Narula, Tanuja Sheth, and K.C. Anand
- Subjects
B Lymphoblastic Lymphoma ,medicine.medical_specialty ,Proportional hazards model ,business.industry ,Cancer ,Care center ,medicine.disease ,Lymphoma ,Internal medicine ,Toxicity ,medicine ,Stage (cooking) ,business ,Disease burden - Abstract
Background: Pediatric B-Lymphoblastic lymphoma(pB-LBL) is a rare entity, and appropriate treatment for pB-LBL is not well defined. While intensive Acute Lymphoblastic leukemia(ALL) type regimens achieve long term event free survival of 90% across western co-operative group trials, published data from Asian studies on long term outcomes in pB-LBL are scarce. We evaluated the outcomes and prognostic factors of pediatric B-LBL patients treated at our center. Methods: We retrospectively analyzed the data of pediatric B-LBL patients treated between January 2010 and December 2017 on a uniform protocol(modified BFM 90). Patients were evaluated for early response post-induction and monitored for toxicity and long term outcomes. Kaplan-Meier method was used to estimate the event free survival(EFS) and overall survival(OS). Cox regression models were performed to identify prognostic factors. Results: Of 21 patients who received treatment on the modified BFM 90 protocol, 17(81%) were alive in remission, 3(14%) had relapse, and 1(4%) had treatment-related mortality(TRM) while in remission. Two of 3 relapsed patients subsequently expired. With a median follow-up of 66 months(range 6–114), 5-year Event free survival(EFS) and overall survival(OS) were 80%(95% CI:71–89%) and 91% (95% CI:85–97%), respectively. While delayed presentation (≥3 months) had inferior EFS(p-0.030), patients with elevated baseline Lactate Dehydrogenase(LDH) had a worse OS(p-0.037). Age, gender, site of origin, stage, and post-induction response had no bearing on outcome. Conclusions: Outcomes of pB-LBL patients treated on modified BFM 90 protocol are excellent. Higher disease burden manifested by elevated baseline LDH and delayed presentation(≥3 months) portend poorer survival.
- Published
- 2021
- Full Text
- View/download PDF