The clinical outcome and prognosis of pediatric mature B cell lymphoma

Abstract

Background: To improve the clinical outcome and prognosis of mature B cell lymphoma, we use modified LMB89 protocol (high dose, short course) combined with correctly diagnosis and precisely individually treatment. Purpose: Summarize the clinical pathology characteristics of pediatric B cell lymphoma, compare the outcome of 2 protocols, BCH-2003 vs BCH-2009 (both were modified from LMB 89). Methods: From March 2003 to June 2015, 246 cases of B cell lymphoma were enrolled. According to the treatment time, 246 patients were divided into 2 groups, BCH-2003(71 cases) and BCH-2009 (175 cases). In group 03, on the basis of different stage and risk factor, there were 3 subgroup: A, B, and C. However, in group 09, according to the stage, risk factor, biomarkers, MDD test, and CNS status, there were A, B1, B2, C1, C2, and C3 subgroups, the treatment course range from 4 months to 6 months separately. Four evaluations were on day 7, after the third and the fifth course, and off treatment separately, and we could tailor the treatment to the evaluation results. Results: Among the 246 cases, 195 were BL (79.2%), 7 were BLL (2.8%), 40 were DLBCL(16.2%), and 3cases were FL (1.2%).The most common symptoms were acute abdomen, facial, and cervical mass. One hundred six cases had BM involvement, which contains 79 leukemia stage, 51 cases had CNS involvement. For the stage, 28 cases were stage I-II (11.4%), stage III-IV were 218例 (88.6%). The median follow-up time was 88.7 months (1-146 months), and all cases were off treatment. In group 03, 5y-OS was 85.2%, 5y-EFS was 83.1%. In group 09, 5y-OS was 87.4%, and 5y-EFS was 83.8%. There were 35 events (2003, n = 10; 2009, n = 25), PD cases were 11, relapse cases were 13, 12/13 cases were relapsed within 6 months off treatment, only the rest 2 cases were alive. Eleven cases were chemo-related death, and 4 cases were quit the treatment. Univariate analysis showed stage IV, CNS involvement, unable to get CR after 3 months treatment, bulky disease, leukemia stage were prognostic factor. Conclusion: The clinical outcome of B cell lymphoma was substantial improved under the BCH-B-NHL protocol, which was modified from LMB89 (high dose, short term). The prognosis of group 09 was better than group 03, although there was no statistics significance between 2 groups. Prognosis factor were stage IV, CNS involvement, unable to get CR after 3 months treatment, bulky disease, and leukemia stage. Keywords: B-cell lymphoma; chemotherapy