Introduction
Anaplastic large cell lymphoma (ALCL) accounts for 10–15% of all childhood non-Hodgkin lymphoma (NHL) cases [1]. In most series, 20–40% of the patients develop recurrent disease. One of the unique features of ALCL is its sensitivity to chemotherapy after recurrence, leading to a survival rate of more than 90% in the ALCL99 study [2,3]. Although there is no standard approach for the treatment of recurrent ALCL, a regimen of single-drug weekly vinblastine has been shown to be highly effective for pediatric patients with relapsed ALCL, yielding an 83% complete remission (CR) rate with 9 of 25 of these patients experiencing continuous remission after a median follow-up of 7 years from the end of treatment [4]. However, vinblastine would not be advised as a treatment option for relapsed ALCL in mainland China due to its inaccessibility (drug shortage).
Vinorelbine is a semi-synthetic vinca alkaloid approved by the U.S. Food and Drug Administration in 1994. Vinca alkaloids are the earliest developed microtubule-targeting agents and have high anti-tumor potential as they interfere with the continuous mitotic division of cancer cells and thereby disrupt their abnormal growth [5]. Vinorelbine has a broad spectrum of anticancer activity, especially in the treatment of advanced/metastatic non-small cell lung cancer and breast cancer, either as a single agent or in combination with other drugs [5]. It is also worth noting that vinorelbine has demonstrated marked single-agent clinical activity (50%) in patients with heavily pre-treated relapsed Hodgkin’s lymphoma (HL) and ranks as one of the active agents in the management of HL [6]. This evidence suggests that this agent is effective in CD30+/ALK+ disease. In the pediatric setting, the maximum tolerated dose is 30 mg/m2/week [7]. The current study reports a pilot experience using single-drug vinorelbine as a salvage re-induction regimen in pediatric patients with relapsed ALCL.