loading page

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
  • +10
  • 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

Corresponding Author:[email protected]

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

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.