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Improved outcome in childhood B-cell lymphoma with the intensified French LMB protocol
1Institute of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Beilinson Campus, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Insights
A modified French LMB protocol significantly improved event-free survival for childhood B cell lymphoma patients, achieving a 94% cure rate, even in advanced stages. This intensive chemotherapy offers high success in pediatric oncology.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Retrospective analysis of 120 children with B cell lymphoma treated over 20 years.
- Comparison between institutional BMC protocol (63 patients) and modified French LMB protocol (57 patients).
Purpose of the Study:
- To compare the efficacy of two different treatment protocols for childhood B cell lymphoma.
- To evaluate event-free survival rates and complications associated with each protocol.
Main Methods:
- Retrospective analysis of patient data.
- Comparison of patient characteristics including disease stage and lactate dehydrogenase (LDH) levels.
- Evaluation of event-free survival and complications.
Main Results:
- Modified LMB protocol achieved 94% event-free survival (median follow-up 73 months).
- Stage IV patients on LMB protocol had 77% event-free survival, compared to 10% previously.
- Major complications included severe marrow suppression and neutropenic enterocolitis.
Conclusions:
- Intensive chemotherapy with a modified LMB protocol yields high cure rates in childhood B cell lymphoma.
- Modern supportive care enhances treatment outcomes, even for advanced disease stages.
- The modified LMB protocol demonstrates superior efficacy compared to the previous BMC protocol.
Background:
During the last 20 years, 120 children with B cell lymphoma were treated at the National Pediatric Hematology/Oncology Center of Israel. Until 1986, 63 patients received an institutional protocol (BMC), and thereafter 57 patients received a modified French LMB protocol. We report the results of a retrospective analysis comparing the results of these two protocols.
Procedure:
Patient characteristics were similar in both groups except for stage of disease and lactate dehydrogenase (LDH) levels. Significantly more patients in the LMB group had higher stage disease, and the LDH levels also were higher (<600 microg/ml).
Results:
Fifty-four of fifty-seven children on the modified LMB protocol are alive, disease-free, with an overall event-free survival of 94% (median follow-up of 73 months). Event-free survival for stages I, II, and III patients is 100%, and for stage IV 77%, whereas the overall event-free survival was 58% among 63 children treated previously, and for stage IV patients only 10%. Severe marrow suppression and neutropenic enterocolitis were the major complications of this intensive protocol.
Conclusions:
Intensive chemotherapy with a modified LMB protocol and modern supportive care result in a high cure rate of childhood B cell lymphoma even in patients with advanced disease.