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Published on: October 19, 2014
The Prognostic and Risk Factors for Children With High-Risk Mature B-Cell Non-Hodgkin's Lymphoma: A Retrospective
Xiaoming Wang1, Luping Ding1, Yongjun Fang2
1Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
Insights
High-risk pediatric B-cell non-Hodgkin
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Previous studies identified favorable outcomes for low-risk pediatric B-cell non-Hodgkin's lymphoma (B-NHL).
- High-risk pediatric B-NHL groups require improved treatment strategies and prognostic factors.
- This study focuses on identifying prognostic factors in stage III and IV pediatric B-NHL.
Purpose of the Study:
- To identify factors influencing prognosis in high-risk pediatric B-cell non-Hodgkin's lymphoma (B-NHL).
- To refine risk stratification and treatment protocols for pediatric B-NHL.
Main Methods:
- Retrospective analysis of pediatric B-NHL patients in China.
- Evaluation of prognostic factors including gender, lactate dehydrogenase (LDH) levels, disease stage, and early complete remission (CR).
- Analysis of event-free survival (EFS) rates based on treatment and disease characteristics.
Main Results:
- Gender, LDH level, stage, and early CR achievement significantly impact pediatric B-NHL prognosis (p < 0.05).
- Patients in the R4 group without rituximab had a 3-year EFS of 25.0%.
- Stage IV patients with bone marrow (BM) and central nervous system (CNS) involvement had significantly lower 5-year EFS (37.5%) compared to isolated BM or CNS involvement (83.0% and 81.8%, respectively).
- Stage III patients with high LDH (≥4N) not achieving CR after 2 cycles had lower 5-year EFS (67.9%) than those achieving CR (88.9%).
Conclusions:
- Rituximab treatment benefits pediatric B-NHL patients in the R4 group.
- Children with stage III, high LDH not achieving early CR, or with combined BM and CNS involvement face high treatment failure risk.
- Findings support optimizing risk stratification and treatment protocols for pediatric B-NHL.
Backgrounds And Aims:
Our previous study (CCCG-BNHL-2015) reported the treatment strategies and outcomes of pediatric B-cell non-Hodgkin's lymphoma (B-NHL) in China which showed that children in low-risk groups already have a dramatically favorable prognosis. However, for high-risk groups, the prognosis still needs to be improved. In this study, we aimed to identify the factors influencing prognosis in high-risk groups (stage III and stage IV).
Results:
Our results revealed that gender, lactate dehydrogenase (LDH) level, stage at the time of diagnosis, and early complete remission (CR) achievement were significant factors influencing prognosis (p < 0.05). The 3-year EFS rate for R4 group patients without rituximab treatment was only 25.0% ± 20.4%. Among all patients in stage IV, the 5-year EFS rates for those with involvement of only bone marrow (BM) or central nervous system (CNS) were 83.0% ± 4.5%, 81.8% ± 8.2%, but the 5-year EFS rates for those with both BM and CNS involved were only 37.5% ± 15.3% (p = 0.002). For stage III patients with LDH ≥ 4N, the 5-year EFS rates for those achieving CR and those not achieving CR after 2 treatment cycle were 88.9% ± 5.2% and 67.9% ± 7.3%(p = 0.036).
Conclusions:
Therefore, R4 group patients benefited from rituximab treatment. However, children at stage III, LDH ≥ 4N not achieving CR after the 2nd treatment cycle, and those with both BM and CNS involved are still at a very high risk of treatment failure. This study serves as a crucial reference for optimizing risk stratification, refining treatment categorizations, and optimizing treatment protocols.
