SCIENTIFIC ADVANCES

Highly Effective, Less Toxic Therapy for Mature B-cell non-Hodgkin Lymphoma (NHL) in Children

The FAB/LMB96 trial for children with mature B-cell NHL, such as Burkitt lymphoma, was an international collaboration that included COG researchers as well as investigators from France and the United Kingdom. One objective of the study was to assess the possibility of reducing treatment in children with intermediate-risk mature B-cell NHL without jeopardizing survival. Patients in this risk group were randomized to receive the previous standard therapy or to receive an experimental treatment in which the cyclophosphamide dose and/or the duration of treatment was reduced. Children receiving the reduced treatment had 4-year event-free survival rates exceeding 90 percent, demonstrating that this group of patients can be cured with a four-course treatment with a total dose of only 3.3 g/m² cyclophosphamide and only 120 mg/m² doxorubicin.

The FAB/LMB96 study additionally attempted to reduce treatment without lowering outcome in patients with high-risk characteristics who had either CNS involvement, extensive bone marrow involvement, or both. For high-risk patients, those receiving the standard treatment had superior outcome compared to those receiving reduced treatment. Patients with bone marrow involvement and no CNS disease receiving the standard treatment had four-year EFS of 91 percent, while those with CNS disease had 4-year event-free survival of 75 percent.

The FAB/LMB96 study optimized treatment for children with mature B-cell NHL and demonstrated the feasibility of large international trials for children with cancer.

Cairo MS, Gerrard M, Sposto R, Auperin A, Pinkerton CR, Michon J, Weston C, Perkins SL, Raphael M, McCarthy K, Patte C; FAB LMB96 International Study Committee. Results of a randomized international study of high-risk central nervous system B non-Hodgkin lymphoma and B acute lymphoblastic leukemia in children and adolescents. Blood2007:109;2736–43.
http://www.ncbi.nlm.nih.gov/pubmed/17138821

Patte C, Auperin A, Gerrard M, Michon J, Pinkerton R, Sposto R, Weston C, Raphael M, Perkins SL, McCarthy K, Cairo MS; FAB/LMB96 International Study Committee. Results of the randomized international FAB/LMB96 trial for intermediate risk B-cell non-Hodgkin lymphoma in children and adolescents: It is possible to reduce treatment for the early responding patients. Blood2007:109;2773–80.
http://www.ncbi.nlm.nih.gov/pubmed/17132719