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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
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  • Kalasekhar Vijayasekharan,
  • Anand KC,
  • Maya Prasad,
  • Chetan Dhamne,
  • Nirmalya Roy Moulik,
  • Tanuja Sheth,
  • Epari Sridhar,
  • Siddhartha Laskar,
  • Seema Kembhavi,
  • Sneha Shah,
  • Sumeet Gujral,
  • Gaurav Narula,
  • Sripad Banavali
Kalasekhar Vijayasekharan
Tata Memorial Hospital
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Anand KC
Tata Memorial Hospital
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Maya Prasad
Tata Memorial Hospital
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Chetan Dhamne
Tata Memorial Hospital
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Nirmalya Roy Moulik
Tata Memorial Hospital
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Tanuja Sheth
Tata Memorial Centre
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Epari Sridhar
Tata Memorial Centre
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Siddhartha Laskar
Tata Memorial Hospital
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Seema Kembhavi
Tata Memorial Hospital
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Sneha Shah
Tata Memorial Centre
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Sumeet Gujral
Tata Memorial Hospital
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Gaurav Narula
Tata Memorial Centre
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Sripad Banavali
Tata Memorial Hospital
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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.