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.