Korean J Hematol 2011; 46(2):
Published online June 21, 2011
https://doi.org/10.5045/kjh.2011.46.2.96
© The Korean Society of Hematology
1Department of Pediatrics, Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea.
2Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Correspondence to : Correspondence to Hyo Seop Ahn, M.D., Ph.D. Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-799, Korea. Tel: +82-2-2072-3625, Fax: +82-2-743-3455, hsahn@snu.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
We compared the outcomes of patients with Burkitt lymphoma and French-American-British (FAB) L3 acute lymphoblastic leukemia treated using Lymphoma Malignancy B (LMB) or other treatment protocols.
Thirty-eight patients diagnosed between July 1996 and December 2007 were treated using LMB 96, and 22 patients diagnosed between January 1991 and May 1998 (defined as the early period) were treated using the D-COMP or CCG-106B protocols. We retrospectively reviewed their medical records and analyzed cumulative survival according to the treatment period by using Kaplan-Meier analysis.
There were no intergroup differences in the distribution of age, disease stage, or risk group. The median follow-up period of the 33 live patients in the LMB group was 72 months (range, 36-170 months). Overall survival (OS) and event-free survival (EFS) of patients treated using LMB 96 were 86.8%±5.5% and 81.6%±6.3%, respectively, whereas OS and EFS of patients treated in the early period were 72.7%±9.6% and 68.2%±9.9%, respectively. In the LMB 96 group, OS of cases showing non-complete response (N=8) was 62.5%±17.1%, and OS of relapsed or primary refractory cases (N=6) was 33.3%±19.3%. Central nervous system (CNS) disease, high lactate dehydrogenase levels at diagnosis, and treatment response were significant prognostic factors.
Survival outcome has drastically improved over the last 2 decades with short-term, dose-intensive chemotherapy. However, CNS involvement or poor response to chemotherapy was worse prognostic factors; therefore, future studies addressing this therapeutic challenge are warranted.
Keywords Burkitt lymphoma, L3 lymphocytic leukemia, Treatment outcome, Prognosis
Korean J Hematol 2011; 46(2): 96-102
Published online June 21, 2011 https://doi.org/10.5045/kjh.2011.46.2.96
Copyright © The Korean Society of Hematology.
Eun Sil Park1, Hyery Kim2, Ji Won Lee2, Jae-Young Lim1, Hyoung Jin Kang2, Kyung Duk Park2, Hee Young Shin2, and Hyo Seop Ahn2*
1Department of Pediatrics, Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea.
2Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Correspondence to: Correspondence to Hyo Seop Ahn, M.D., Ph.D. Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-799, Korea. Tel: +82-2-2072-3625, Fax: +82-2-743-3455, hsahn@snu.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
We compared the outcomes of patients with Burkitt lymphoma and French-American-British (FAB) L3 acute lymphoblastic leukemia treated using Lymphoma Malignancy B (LMB) or other treatment protocols.
Thirty-eight patients diagnosed between July 1996 and December 2007 were treated using LMB 96, and 22 patients diagnosed between January 1991 and May 1998 (defined as the early period) were treated using the D-COMP or CCG-106B protocols. We retrospectively reviewed their medical records and analyzed cumulative survival according to the treatment period by using Kaplan-Meier analysis.
There were no intergroup differences in the distribution of age, disease stage, or risk group. The median follow-up period of the 33 live patients in the LMB group was 72 months (range, 36-170 months). Overall survival (OS) and event-free survival (EFS) of patients treated using LMB 96 were 86.8%±5.5% and 81.6%±6.3%, respectively, whereas OS and EFS of patients treated in the early period were 72.7%±9.6% and 68.2%±9.9%, respectively. In the LMB 96 group, OS of cases showing non-complete response (N=8) was 62.5%±17.1%, and OS of relapsed or primary refractory cases (N=6) was 33.3%±19.3%. Central nervous system (CNS) disease, high lactate dehydrogenase levels at diagnosis, and treatment response were significant prognostic factors.
Survival outcome has drastically improved over the last 2 decades with short-term, dose-intensive chemotherapy. However, CNS involvement or poor response to chemotherapy was worse prognostic factors; therefore, future studies addressing this therapeutic challenge are warranted.
Keywords: Burkitt lymphoma, L3 lymphocytic leukemia, Treatment outcome, Prognosis
LMB 96 protocol schedule [8]. Patients were stratified into 3 risk groups: A, B, and C, depending on stage, resection status, percentage of blasts in BM, and CNS involvement. Group A: Resected stage I and abdominal stage II. Group B: Patients not eligible for inclusion in group A or C. Group C: Patient with CNS involvement and more than 70% of blast in bone marrow. In the LMB 96 protocol, cranial irradiation was skipped and replaced with high-dose methotrexate (MTX) between consolidation phases in patients with CNS-positive disease.
Outcome in patients treated using the LMB protocol. Three patients showed relapse (RL) after complete response (CR), and 2 of them responded to salvage therapy and are alive with no evidence of disease. Cases that did not show CR after the first consolidation chemotherapy included 5 cases of partial response (PR) and 3 refractory (ref) cases. One case of toxic death occurred during induction chemotherapy.
Survival outcome of patients treated using LMB 89 (1996-2007)
Event-free survival according to stage
Comparative analysis of event-free survival (EFS) according to the involvement of bone marrow. EFS of patients treated using the LMB protocol
Comparative analysis of event-free survival (EFS) according to the involvement of the central nervous system (CNS). EFS of patients treated using the LMB protocol
Table 1 . Demographic and disease characteristics..
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LMB 96 protocol schedule [8]. Patients were stratified into 3 risk groups: A, B, and C, depending on stage, resection status, percentage of blasts in BM, and CNS involvement. Group A: Resected stage I and abdominal stage II. Group B: Patients not eligible for inclusion in group A or C. Group C: Patient with CNS involvement and more than 70% of blast in bone marrow. In the LMB 96 protocol, cranial irradiation was skipped and replaced with high-dose methotrexate (MTX) between consolidation phases in patients with CNS-positive disease.
|@|~(^,^)~|@|Outcome in patients treated using the LMB protocol. Three patients showed relapse (RL) after complete response (CR), and 2 of them responded to salvage therapy and are alive with no evidence of disease. Cases that did not show CR after the first consolidation chemotherapy included 5 cases of partial response (PR) and 3 refractory (ref) cases. One case of toxic death occurred during induction chemotherapy.
|@|~(^,^)~|@|Survival outcome of patients treated using LMB 89 (1996-2007)
Event-free survival according to stage
Comparative analysis of event-free survival (EFS) according to the involvement of bone marrow. EFS of patients treated using the LMB protocol
Comparative analysis of event-free survival (EFS) according to the involvement of the central nervous system (CNS). EFS of patients treated using the LMB protocol