Results
Four consecutive patients aged between 4 and 13 years at initial diagnosis were treated. The disease relapse was confirmed through biopsy in all 4 patients. All the patients were initially treated according to CCCG-BNHL-2010 (a 6-month chemotherapy regimen combining vincristine, doxorubicin, cyclophosphamide, prednisone, high-dose methotrexate, etoposide, and triple intrathecal therapy) [8].
All 4 patients achieved a CR after 2 cycles of weekly vinorelbine. Patients 1 and 2 underwent autologous hematopoietic stem-cell transplantation (HSCT) afterwards, and both had a second relapse, 18 months and 24 months after the first one, respectively. Fortunately, those 2 patients achieved their CR3 after receiving 3 cycles of multiagent chemotherapy combined with crizotinib. Both refused further allogeneic HSCT but continued on crizotinib and remained in CR3 at last evaluation. Patient 3 underwent allogeneic HSCT afterwards and remained in his CR2. Patient characteristics, treatments, and outcomes are shown in Table 1.
The main toxicity related to weekly vinorelbine was hematologic. In total, 4 patients received 24 cycles of weekly vinorelbine. Table 2 summarizes the grade 3 and 4 toxic effects. Only 1 week of vinorelbine administration was withheld, for a grade 4 neutropenia in Patient 1.