Treatment of pediatric B-cell non-Hodgkin's lymphomas at the Motol Hospital in Prague, Czech Republic: Results based on the NHL BFM 90 protocols

Malignant non-Hodgkin's lymphomas (NHL) of childhood and adolescence are a heterogeneous group of diseases originating from the lymphoid cells. Unlike adults with non-Hodgkin's lymphoma, children typically have extranodal dis seminated disease of high grade (Burkitt's lymphoma, large cell lymphoma, o r lymphoblastic lymphoma). This study was conducted to determine the feasib ility of treating children in the Czech Republic with B-cell non-Hodgkin's lymphomas according to very intensive protocols based on the German Berlin Frankfurt Munster (BFM) NHL 90 study. Treatments are divided in the BFM stu dies according to "B" and "non-B " immunophenotypes, The authors report onl y those treated according to the BFM B-cell protocol. From 1991 through 199 7 eighty-two patients less than 18 years with NHL were admitted to the depa rtment. Seventy-three of them were classified as B-cell lymphoma and 54 wer e thus eligible for the BFM B-cell treatment. The entire group consisted of 38 males and 16 females (ratio 2.38). Median age was 11.6 years. Twelve ha d stage I disease, 3 stage 11, 30 stage Ill; and 9 stage IV lymphoma. There were 21 patients with Burhitt's lymphoma, 29 with large cell lymphoma, of which 5 were patients with MALT Il lymphoma. In 3 cases B-cell NHL was not further classified and one child had a mediastinal B lymphoma. Patients wer e furher stratified according to clinical stage and lactate dehydrogenase ( LDH) level. Therapy consisted of a prephase and short (2, 4, or 6 courses), intensive 5-day therapy with 6 drugs. The probability of event-free surviv al (pEFS)fm the entire group was 74% and overall survival at 5 years was 80 %. There was a significantly better outcome for children classified as stag e I. No difference was observed between the EFS of stage III and IV patient s. Four patients died from treatment-related complications in complete remi ssion. Treatment results were not identical between NHL subtypes, with larg e cell lymphoma patients doing significantly better (pEFS 90%, p =.008). Th e use of protocols based on BFM 90 study was feasible at this center. The t reatment results are approximately 10% lower than those reported by BFM inv estigators, but comparable to results from other centers.