The Societe Francaise d'Oncologie Pediatrique LMB89 protocol: highly effective multiagent chemotherapy tailored to the tumor burden and initial response in 561 unselected children with B-cell lymphomas and L3 leukemia

This study was undertaken to show that a high survival rate can be obtained in B-cell(Burkitt and large B-cell) lymphoma and L3 leukemia with multiage nt chemotherapy adapted to the tumor burden (stage, resection status, perce ntage of blasts in bone marrow, and central nervous system [CNS] involvemen t) and early response to chemotherapy, to investigate actual prognostic fac tors, and to see if large B-cell lymphoma can be treated with the same regi men as Burkitt lymphoma. Patients were classified into 3 risk groups. Group A (resected stage I and abdominal stage II) received 2 courses of vincrist ine, cyclophosphamide, doxorubicin, and prednisone. Group B (patients not e ligible for groups A or C) received 5 courses of chemotherapy with, in addi tion, high-dose methotrexate, 3 g/m(2) over 3 hours; infusional cytarabine; and intrathecal (IT) methotrexate. Group C (patients with CNS involvement and acute lymphoblastic leukemia with at least 70% of blasts in bone marrow ) received 8 courses with, in addition, high-dose methotrexate, 8 g/m(2); h igh-dose cytarabine; etoposide; and triple IT. Except in group A, treatment started with a prephase (COP, row-dose vincristine and cyclophosphamide). It was intensified for patients who did not respond to COP in group B and a ny patient with residual viable cells after the consolidation phase. A tota l of 561 patients were enrolled in the SFOP LMB89 protocol (July 1989-June 1996). Five-year survival is 92.5% (95% confidence interval [CL], 90%-94%) and event-free survival (EFS) 91% (95% Cl, 89%-93%). EFS is 98% (95% Cl, 90 %-100%), 92% (95% Cl, 89%-95%), and 84% (95% Cl, 77%-90%) for group A, B, a nd C, respectively. In group B, multivariate analysis of prognostic factors showed that a lactate dehydrogenase level more than P-fold the normal valu e, no response after COP, and age of at least 15 years were associated with a lower EFS. CNS involvement was the only prognostic factor in group C.(Bl ood. 2001;97:3370-3379).