Pediatric Non-Hodgkin Lymphoma Medication

  • Author: J Martin Johnston, MD; Chief Editor: Max J Coppes, MD, PhD, MBA   more...
 
Updated: Apr 8, 2011
 

Medication Summary

As discussed Medical Care, the agents described below are used in combination regimens, and doses are tailored to the histologic subtype of lymphoma and stage of disease present.

Next

Corticosteroids

Class Summary

Corticosteroids elicit anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

View full drug information

Methylprednisolone (Medrol)

 

Mechanism of cytotoxicity unknown but apparently mediated by glucocorticoid receptors.

View full drug information

Dexamethasone (Decadron)

 

Mechanism of cytotoxicity unknown, but apparently mediated by glucocorticoid receptors; apparently enhanced CNS penetration (relative to prednisone).

Previous
Next

Antineoplastic Agents

Class Summary

Cancer chemotherapy is based on an understanding of tumoral cell growth and on how drugs affect this growth. After cells divide, they enter a period of growth (ie, phase G1), followed by DNA synthesis (ie, phase S). The next phase is the premitotic phase (ie, G2), then finally mitotic cell division (ie, phase M).

Cell division rates vary for different tumors. Most common cancers grow slowly compared with normal tissues, and the growth rate may further decrease in large tumors. This difference allows normal cells to recover from chemotherapy more quickly than malignant cells, and is the rationale for current cyclic dosage schedules.

Antineoplastic agents interfere with cell reproduction. Some agents are cell cycle specific, whereas others (eg, alkylating agents, anthracyclines, cisplatin) are not phase specific.

Cellular apoptosis (ie, programmed cell death) is another potential mechanism of many antineoplastic agents.

View full drug information

Daunorubicin (Cerubidine)

 

Anthracycline. Multiple mechanisms of action involve DNA intercalation, topoisomerase-mediated DNA strand breakage, and oxidative damage due to free radical production.

View full drug information

Doxorubicin (Adriamycin)

 

Anthracycline. Multiple mechanisms of action involve DNA intercalation, topoisomerase-mediated DNA strand breakage, and oxidative damage due to free radical production.

View full drug information

Cytarabine (Cytosine arabinoside, Ara-C, Cytosar-U)

 

Antimetabolite. Cytotoxic analog of deoxycytidine. Interferes with DNA replication and repair by incorporating into DNA and inhibiting DNA polymerase.

View full drug information

6-mercaptopurine (6-MP, Purinethol)

 

Purine analog. Metabolites incorporated into DNA, inhibiting synthesis.

View full drug information

6-thioguanine (Purinethol)

 

Purine analog. Metabolites are incorporated into DNA, inhibiting synthesis

View full drug information

Methotrexate (MTX, Folex PFS)

 

Cytotoxic folate antagonist. Inhibits dihydrofolate reductase.

View full drug information

Vincristine (Oncovin)

 

Inhibits microtubule formation in mitotic spindle, causing metaphase arrest.

View full drug information

Etoposide (VP-16, Toposar)

 

Inhibits topoisomerase, causing DNA strand breaks.

View full drug information

Cyclophosphamide (Cytoxan)

 

Alkylates and cross-links DNA.

View full drug information

Ifosfamide (Ifex)

 

Alkylates and cross-links DNA.

View full drug information

Carmustine (BCNU, BiCNU)

 

Alkylates DNA and RNA; may also act by carbamoylation of enzymes.

View full drug information

L-asparaginase (Elspar)

 

Enzyme produced by Escherichia coli, which catalyzes conversion of L-asparagine to aspartic acid; former is nonessential amino acid for most normal tissues. Many lymphoid malignancies have low levels of asparagine synthase and, therefore, depend on circulating pool of L-asparagine.

View full drug information

Nelarabine (Arranon)

 

Prodrug of deoxyguanosine analog 9-beta-D-arabinofuranosylguanine (Ara-G). Converted to active 5'-triphosphate (ara-GTP), a T-cell–selective nucleoside analog. Leukemic blast cells accumulate ara-GTP, allowing for incorporation into DNA; result is inhibition of DNA synthesis and cell death.

Approved by US Food and Drug Administration as orphan drug to treat T-cell lymphoblastic lymphoma not responding to or relapsing with at least 2 chemotherapy regimens.

View full drug information

Hydroxyurea (Hydrea)

 

Apparently inhibits DNA synthesis.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

J Martin Johnston, MD  Associate Professor of Pediatrics, Mercer University School of Medicine; Director of Pediatric Hematology/Oncology, Backus Children's Hospital; Consulting Oncologist/Hematologist, St Damien's Pediatric Hospital

J Martin Johnston, MD is a member of the following medical societies: American Academy of Pediatrics and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Kathleen M Sakamoto, MD, PhD  Professor and Chief, Division of Hematology-Oncology, Vice-Chair of Research, Mattel Children's Hospital at UCLA; Co-Associate Program Director of the Signal Transduction Program Area, Jonsson Comprehensive Cancer Center, California Nanosystems Institute and Molecular Biology Institute, University of California, Los Angeles, David Geffen School of Medicine

Kathleen M Sakamoto, MD, PhD is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology, International Society for Experimental Hematology, Society for Pediatric Research, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Timothy P Cripe, MD, PhD  Professor of Pediatrics, Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center; Clinical Director, Musculoskeletal Tumor Program, Co-Medical Director, Office for Clinical and Translational Research, Cincinnati Children's Hospital Medical Center; Director of Pilot and Collaborative Clinical and Translational Studies Core, Center for Clinical and Translational Science and Training, University of Cincinnati College of Medicine

Timothy P Cripe, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Samuel Gross, MD  Professor Emeritus, Department of Pediatrics, University of Florida; Clinical Professor, Department of Pediatrics, University of North Carolina; Adjunct Professor, Department of Pediatrics, Duke University

Samuel Gross, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA  Senior Vice President, Center for Cancer and Blood Disorders, Children's National Medical Center; Professor of Medicine, Oncology, and Pediatrics, Georgetown University School of Medicine; Clinical Professor of Pediatrics, George Washington University School of Medicine and Health Sciences

Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American Association for Cancer Research, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. Shad A, Magrath I. Malignant non-Hodgkin's lymphomas in children. In: Principles and Practice of Pediatric Oncology. 1997:545-87.

  2. Jaffe ES. The 2008 WHO classification of lymphomas: implications for clinical practice and translational research. Hematology Am Soc Hematol Educ Program. 2009;523-31. [Medline].

  3. Martinez-Climent JA, Fontan L, Gascoyne RD, Siebert R, Prosper F. Lymphoma stem cells: enough evidence to support their existence?. Haematologica. 2010;95(2):293-302. [Medline].

  4. Cancer in children (ages 0-14 and ages 0-19). In: Horner MJ, Ries LAG, Krapcho M, eds. SEER Cancer Statistics Review, 1975-2006. Bethesda, Md: National Cancer Institute; 2008:[Full Text].

  5. Liu S, Semenciw R, Mao Y. Increasing incidence of non-Hodgkin's lymphoma in Canada, 1970-1996: age-period-cohort analysis. Hematol Oncol. 2003;21(2):57-66. [Medline].

  6. Fadoo Z, Belgaumi A, Alam M, Azam I, Naqvi A. Pediatric lymphoma: a 10-year experience at a tertiary care hospital in Pakistan. J Pediatr Hematol Oncol. 2010;32(1):e14-8. [Medline].

  7. Amodio J, Brodsky JE. Pediatric Burkitt lymphoma presenting as acute pancreatitis: MRI characteristics. Pediatr Radiol. 2010;40(5):770-2. [Medline].

  8. Kadin ME, Sako D, Berliner N, Franklin W, Woda B, Borowitz M. Childhood Ki-1 lymphoma presenting with skin lesions and peripheral lymphadenopathy. Blood. Nov 1986;68(5):1042-9. [Medline]. [Full Text].

  9. Kumar S, Pittaluga S, Raffeld M, Guerrera M, Seibel NL, Jaffe ES. Primary cutaneous CD30-positive anaplastic large cell lymphoma in childhood: report of 4 cases and review of the literature. Pediatr Dev Pathol. Jan-Feb 2005;8(1):52-60. [Medline].

  10. Al-Tonbary Y, Abdel-Razek N, Zaghloul H, Metwaly S, El-Deek B, El-Shawaf R. HLA class II polymorphism in Egyptian children with lymphomas. Hematology. Apr 2004;9(2):139-45. [Medline].

  11. Vadivelu MK, Damodaran S, Solomon J, Rajaseharan A. Distribution of ABO blood groups in acute leukaemias and lymphomas. Ann Hematol. Sep 2004;83(9):584-7. [Medline].

  12. Quintana PJ, Delfino RJ, Korrick S, Ziogas A, Kutz FW, Jones EL. Adipose tissue levels of organochlorine pesticides and polychlorinated biphenyls and risk of non-Hodgkin's lymphoma. Environ Health Perspect. Jun 2004;112(8):854-61. [Medline]. [Full Text].

  13. Zahm SH, Ward MH. Pesticides and childhood cancer. Environ Health Perspect. Jun 1998;106 Suppl 3:893-908. [Medline]. [Full Text].

  14. Pearce MS, Cotterill SJ, Parker L. Fathers' occupational contacts and risk of childhood leukemia and non-hodgkin lymphoma. Epidemiology. May 2004;15(3):352-6. [Medline].

  15. Rangel M, Cypriano M, de Martino Lee ML, Luisi FA, Petrilli AS, Strufaldi MW, et al. Leukemia, non-Hodgkin's lymphoma, and Wilms tumor in childhood: the role of birth weight. Eur J Pediatr. 2010;[Medline].

  16. Hughes AM, Armstrong BK, Vajdic CM, Turner J, Grulich AE, Fritschi L. Sun exposure may protect against non-Hodgkin lymphoma: a case-control study. Int J Cancer. Dec 10 2004;112(5):865-71. [Medline].

  17. Prosper F, Robledo C, Cuesta B, Rifon J, Borbolla JR, Pardo J. Incidence of non-Hodgkin's lymphoma in patients treated for Hodgkin's disease. Leuk Lymphoma. Feb 1994;12(5-6):457-62. [Medline].

  18. Dietrich PY, Henry-Amar M, Cosset JM, Bodis S, Bosq J, Hayat M. Second primary cancers in patients continuously disease-free from Hodgkin's disease: a protective role for the spleen?. Blood. Aug 15 1994;84(4):1209-15. [Medline]. [Full Text].

  19. Eguiguren JM, Ribeiro RC, Pui CH, Hancock ML, Pratt CB, Head DR. Secondary non-Hodgkin's lymphoma after treatment for childhood cancer. Leukemia. Oct 1991;5(10):908-11. [Medline].

  20. Imai S, Sugiura M, Mizuno F, Ohigashi H, Koshimizu K, Chiba S. African Burkitt's lymphoma: a plant, Euphorbia tirucalli, reduces Epstein-Barr virus-specific cellular immunity. Anticancer Res. May-Jun 1994;14(3A):933-6. [Medline].

  21. van den Bosch CA. Is endemic Burkitt's lymphoma an alliance between three infections and a tumour promoter?. Lancet Oncol. Dec 2004;5(12):738-46. [Medline].

  22. Goldsby RE, Carroll WL. The molecular biology of pediatric lymphomas. J Pediatr Hematol Oncol. Jul-Aug 1998;20(4):282-96. [Medline].

  23. Lones MA, Sanger WG, Le Beau MM, Heerema NA, Sposto R, Perkins SL. Chromosome abnormalities may correlate with prognosis in Burkitt/Burkitt-like lymphomas of children and adolescents: a report from Children's Cancer Group Study CCG-E08. J Pediatr Hematol Oncol. Mar 2004;26(3):169-78. [Medline].

  24. Garcia JL, Hernandez JM, Gutierrez NC, Flores T, Gonzalez D, Calasanz MJ. Abnormalities on 1q and 7q are associated with poor outcome in sporadic Burkitt's lymphoma. A cytogenetic and comparative genomic hybridization study. Leukemia. Oct 2003;17(10):2016-24. [Medline].

  25. Cayuela JM, Gardie B, Sigaux F. Disruption of the multiple tumor suppressor gene MTS1/p16(INK4a)/CDKN2 by illegitimate V(D)J recombinase activity in T-cell acute lymphoblastic leukemias. Blood. Nov 1 1997;90(9):3720-6. [Medline]. [Full Text].

  26. Poirel HA, Cairo MS, Heerema NA, et al. Specific cytogenetic abnormalities are associated with a significantly inferior outcome in children and adolescents with mature B-cell non-Hodgkin's lymphoma: results of the FAB/LMB 96 international study. Leukemia. 2008;[Medline].

  27. Liang X, Meech SJ, Odom LF, Bitter MA, Ryder JW, Hunger SP. Assessment of t(2;5)(p23;q35) translocation and variants in pediatric ALK+ anaplastic large cell lymphoma. Am J Clin Pathol. Apr 2004;121(4):496-506. [Medline].

  28. Sandlund JT, Pui CH, Roberts WM, Santana VM, Morris SW, Berard CW. Clinicopathologic features and treatment outcome of children with large-cell lymphoma and the t(2;5)(p23;q35). Blood. Oct 15 1994;84(8):2467-71. [Medline]. [Full Text].

  29. Depas G, De Barsy C, Jerusalem G, Hoyoux C, Dresse MF, Fassotte MF. 18F-FDG PET in children with lymphomas. Eur J Nucl Med Mol Imaging. Jan 2005;32(1):31-8. [Medline].

  30. Schoder H, Noy A, Gonen M, Weng L, Green D, Erdi YE. Intensity of 18fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin's lymphoma. J Clin Oncol. Jul 20 2005;23(21):4643-51. [Medline].

  31. Paes FM, Kalkanis DG, Sideras PA, Serafini AN. FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease. Radiographics. 2010;30(1):269-91. [Medline].

  32. Weiler-Sagie M, Bushelev O, Epelbaum R, Dann EJ, Haim N, Avivi I, et al. (18)F-FDG avidity in lymphoma readdressed: a study of 766 patients. J Nucl Med. 2010;51(1):25-30. [Medline].

  33. Mussolin L, Basso K, Pillon M, D'Amore ES, Lombardi A, Luzzatto L. Prospective analysis of minimal bone marrow infiltration in pediatric Burkitt's lymphomas by long-distance polymerase chain reaction for t(8;14)(q24;q32). Leukemia. Mar 2003;17(3):585-9. [Medline].

  34. Sabesan V, Cairo MS, Lones MA, Perkins SL, Morris E, Sposto R. Assessment of minimal residual disease in childhood non-hodgkin lymphoma by polymerase chain reaction using patient-specific primers. J Pediatr Hematol Oncol. Feb 2003;25(2):109-13. [Medline].

  35. Sethuraman C, Simmerson M, Vora AJ, Cohen MC. Flowcytometric Immunophenotyping in the Diagnosis of Pediatric Lymphoma: How Reliable Is It and How Can We Optimize Its Use?. J Pediatr Hematol Oncol. 2010;[Medline].

  36. Hutchison RE, Finch C, Kepner J, Fuller C, Bowman P, Link M. Burkitt lymphoma is immunophenotypically different from Burkitt-like lymphoma in young persons. Ann Oncol. 2000;11 Suppl 1:35-8. [Medline].

  37. Bovio IM, Allan RW. The expression of myeloid antigens CD13 and/or CD33 is a marker of ALK+ anaplastic large cell lymphomas. Am J Clin Pathol. 2008;130(4):628-34. [Medline].

  38. Murphy SB. Classification, staging and end results of treatment of childhood non-Hodgkin's lymphomas: dissimilarities from lymphomas in adults. Semin Oncol. Sep 1980;7(3):332-9. [Medline].

  39. Hochberg J, Cairo MS. Rasburicase: future directions in tumor lysis management. Expert Opin Biol Ther. 2008;8(10):1595-604. [Medline].

  40. Mora J, Filippa DA, Qin J, Wollner N. Lymphoblastic lymphoma of childhood and the LSA2-L2 protocol: the 30-year experience at Memorial-Sloan-Kettering Cancer Center. Cancer. Sep 15 2003;98(6):1283-91. [Medline].

  41. Tubergen DG, Krailo MD, Meadows AT, Rosenstock J, Kadin M, Morse M. Comparison of treatment regimens for pediatric lymphoblastic non-Hodgkin's lymphoma: a Childrens Cancer Group study. J Clin Oncol. Jun 1995;13(6):1368-76. [Medline].

  42. Reiter A, Schrappe M, Parwaresch R, Henze G, Muller-Weihrich S, Sauter S. Non-Hodgkin's lymphomas of childhood and adolescence: results of a treatment stratified for biologic subtypes and stage--a report of the Berlin-Frankfurt-Munster Group. J Clin Oncol. Feb 1995;13(2):359-72. [Medline].

  43. Abromowitch M, Sposto R, Perkins S, et al. Shortened intensified multi-agent chemotherapy and non-cross resistant maintenance therapy for advanced lymphoblastic lymphoma in children and adolescents: report from the Children's Oncology Group. Br J Haematol. 2008;143(2):261-7. [Medline].

  44. Gerrard M, Cairo MS, Weston C, Auperin A, Pinkerton R, Lambilliote A, et al. Excellent survival following two courses of COPAD chemotherapy in children and adolescents with resected localized B-cell non-Hodgkin's lymphoma: results of the FAB/LMB 96 international study. Br J Haematol. 2008;141(6):840-7. [Medline].

  45. Patte C, Auperin A, Gerrard M, et al. 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. Blood. 2007;109(7):2773-80. [Medline].

  46. Cairo MS, Gerrard M, Sposto R, et al. 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. Blood. 2007;109(7):2736-43. [Medline].

  47. Woessmann W, Seidemann K, Mann G, Zimmermann M, Burkhardt B, Oschlies I. The impact of the methotrexate administration schedule and dose in the treatment of children and adolescents with B-cell neoplasms: a report of the BFM Group Study NHL-BFM95. Blood. Feb 1 2005;105(3):948-58. [Medline].

  48. Lones MA, Perkins SL, Sposto R, Kadin ME, Kjeldsberg CR, Wilson JF. Large-cell lymphoma arising in the mediastinum in children and adolescents is associated with an excellent outcome: a Children's Cancer Group report. J Clin Oncol. Nov 15 2000;18(22):3845-53. [Medline].

  49. Raetz E, Perkins S, Davenport V, Cairo MS. B large-cell lymphoma in children and adolescents. Cancer Treat Rev. Apr 2003;29(2):91-8. [Medline].

  50. Seidemann K, Tiemann M, Lauterbach I, Mann G, Simonitsch I, Stankewitz K. Primary mediastinal large B-cell lymphoma with sclerosis in pediatric and adolescent patients: treatment and results from three therapeutic studies of the Berlin-Frankfurt-Münster Group. J Clin Oncol. May 1 2003;21(9):1782-9. [Medline].

  51. Weinstein HJ, Lack EE, Cassady JR. APO therapy for malignant lymphoma of large cell "histiocytic" type of childhood: analysis of treatment results for 29 patients. Blood. Aug 1984;64(2):422-6. [Medline].

  52. Laver JH, Mahmoud H, Pick TE, Hutchinson RE, Weinstein HJ, Schwenn M. Results of a randomized phase III trial in children and adolescents with advanced stage diffuse large cell non Hodgkin's lymphoma: a Pediatric Oncology Group study. Leuk Lymphoma. Jul 2001;42(3):399-405. [Medline].

  53. Reiter A, Schrappe M, Tiemann M, Parwaresch R, Zimmermann M, Yakisan E. Successful treatment strategy for Ki-1 anaplastic large-cell lymphoma of childhood: a prospective analysis of 62 patients enrolled in three consecutive Berlin-Frankfurt-Munster group studies. J Clin Oncol. May 1994;12(5):899-908. [Medline].

  54. Seidemann K, Tiemann M, Schrappe M, Yakisan E, Simonitsch I, Janka-Schaub G. Short-pulse B-non-Hodgkin lymphoma-type chemotherapy is efficacious treatment for pediatric anaplastic large cell lymphoma: a report of the Berlin-Frankfurt-Münster Group Trial NHL-BFM 90. Blood. Jun 15 2001;97(12):3699-706. [Medline]. [Full Text].

  55. Laver JH, Kraveka JM, Hutchison RE, Chang M, Kepner J, Schwenn M. Advanced-stage large-cell lymphoma in children and adolescents: results of a randomized trial incorporating intermediate-dose methotrexate and high-dose cytarabine in the maintenance phase of the APO regimen: a Pediatric Oncology Group phase III trial. J Clin Oncol. Jan 20 2005;23(3):541-7. [Medline].

  56. Brugières L, Quartier P, Le Deley MC, Pacquement H, Perel Y, Bergeron C. Relapses of childhood anaplastic large-cell lymphoma: treatment results in a series of 41 children--a report from the French Society of Pediatric Oncology. Ann Oncol. Jan 2000;11(1):53-8. [Medline]. [Full Text].

  57. Jetsrisuparb A, Wiangnon S, Komvilaisak P, Kularbkaew C, Yutanawiboonchai W, Mairieng E. Rituximab combined with CHOP for successful treatment of aggressive recurrent, pediatric B-cell large cell non-Hodgkin's lymphoma. J Pediatr Hematol Oncol. Apr 2005;27(4):223-6. [Medline].

  58. Kewalramani T, Zelenetz AD, Nimer SD, Portlock C, Straus D, Noy A. Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma. Blood. May 15 2004;103(10):3684-8. [Medline]. [Full Text].

  59. Pilecki B, Kopiec P, Zajusz A, Podworski H, Szelc S, Skladowski K. Hyperfractionated radiotherapy for Burkitt-type lymphoma. Radiobiological aspects. Neoplasma. 1991;38(6):609-15. [Medline].

  60. Muller HL, Klinkhammer-Schalke M, Kuhl J. Final height and weight of long-term survivors of childhood malignancies. Exp Clin Endocrinol Diabetes. 1998;106(2):135-9. [Medline].

  61. Lahteenmaki PM, Sankila R, Pukkala E, Kyyronen P, Harila-Saari A. Scholastic achievement of children with lymphoma or Wilms tumor at the end of comprehensive education--a nationwide, register-based study. Int J Cancer. 2008;123 (10):2401-5. [Medline].

  62. Haddy TB, Adde MA, McCalla J, Domanski MJ, Datiles M 3rd, Meehan SC. Late effects in long-term survivors of high-grade non-Hodgkin's lymphomas. J Clin Oncol. Jun 1998;16(6):2070-9. [Medline].

  63. Hawkins MM, Wilson LM, Stovall MA, Marsden HB, Potok MH, Kingston JE. Epipodophyllotoxins, alkylating agents, and radiation and risk of secondary leukaemia after childhood cancer. BMJ. Apr 11 1992;304(6832):951-8. [Medline]. [Full Text].

  64. Nysom K, Holm K, Lipsitz SR, Mone SM, Colan SD, Orav EJ. Relationship between cumulative anthracycline dose and late cardiotoxicity in childhood acute lymphoblastic leukemia. J Clin Oncol. Feb 1998;16(2):545-50. [Medline].

  65. Benmiloud S, Steffens M, Beauloye V, de Wandeleer A, Devogelaer JP, Brichard B, et al. Long-Term Effects on Bone Mineral Density of Different Therapeutic Schemes for Acute Lymphoblastic Leukemia or Non-Hodgkin Lymphoma during Childhood. Horm Res Paediatr. 2010;[Medline].

  66. Gilsanz V, Carlson ME, Roe TF, Ortega JA. Osteoporosis after cranial irradiation for acute lymphoblastic leukemia. J Pediatr. Aug 1990;117(2 Pt 1):238-44. [Medline].

  67. Pulte D, Gondos A, Brenner H. Trends in 5- and 10-year survival after diagnosis with childhood hematologic malignancies in the United States, 1990-2004. J Natl Cancer Inst. 2008;100(18):1301-9. [Medline].

  68. Suzuki R, Kagami Y, Takeuchi K, et al. Prognostic significance of CD56 expression for ALK-positive and ALK-negative anaplastic large-cell lymphoma of T/null cell phenotype. Blood. 2000;96(9):2993-3000. [Medline].

  69. Tai E, Pollack LA, Townsend J, Li J, Steele CB, Richardson LC. Differences in non-Hodgkin lymphoma survival between young adults and children. Arch Pediatr Adolesc Med. 2010;164(3):218-24. [Medline].

  70. Sandlund JT. Should adolescents with NHL be treated as old children or young adults?. Hematology Am Soc Hematol Educ Program. 2007;297-303. [Medline].

  71. Kube D, Hua TD, von Bonin F, et al. Effect of interleukin-10 gene polymorphisms on clinical outcome of patients with aggressive non-Hodgkin's lymphoma: an exploratory study. Clin Cancer Res. 2008;14 (12):3777-84. [Medline].

  72. Lee JJ, Kim DH, Lee NY, et al. Interleukin-10 gene polymorphism influences the prognosis of T-cell non-Hodgkin lymphomas. Br J Haematol. 2007;137 (4):329-36. [Medline].

  73. Attarbaschi A, Dworzak M, Steiner M, Urban C, Fink FM, Reiter A. Outcome of children with primary resistant or relapsed non-Hodgkin lymphoma and mature B-cell leukemia after intensive first-line treatment: a population-based analysis of the Austrian Cooperative Study Group. Pediatr Blood Cancer. Jan 2005;44(1):70-6. [Medline].

  74. Smith SM, van Besien K, Carreras J, et al. Second autologous stem cell transplantation for relapsed lymphoma after a prior autologous transplant. Biol Blood Marrow Transplant. 2008;14(8):904-12. [Medline].

  75. Abla O, Weitzman S, Blay JY, O'Neill BP, Abrey LE, Neuwelt E, et al. Primary CNS lymphoma in children and adolescents: a descriptive analysis from the international primary CNS lymphoma collaborative group (IPCG). Clin Cancer Res. Jan 15 2011;17(2):346-52. [Medline].

 
Previous
Next
 
Incidence of lymphoma as a function of age per 100,000 population. Data are from the Surveillance, Epidemiology, and End Results (SEER) for 1990-1994.
Massive mediastinal T-lymphoblastic lymphoma. Note compression of the left mainstem bronchus and the pulmonary atelectasis.
Non-Hodgkin lymphoma of the terminal ileum. Note the doughnut sign, ie, intraluminal contrast material surrounded by a grossly thickened bowel wall. This appearance is highly suggestive of small noncleaved cell lymphoma (Burkitt type).
Malignant pleural effusion. Non-Hodgkin lymphoma of the terminal ileum was diagnosed; the doughnut sign (ie, intraluminal contrast material surrounded by a grossly thickened bowel wall) was present. A diagnosis of stage 3 Burkitt lymphoma was established by means of pleurocentesis. (The bone marrow was normal.) The patient was treated successfully and never required an abdominal procedure.
Massive left pleural effusion as a complication of an upper anterior mediastinal T-lymphoblastic lymphoma. Note the atelectatic left lung. The diagnosis was established by means of thoracentesis. This patient had presented with bilateral parotid gland enlargement.
Table 1. Modified LSA2 L2 Therapy in Children's Cancer Group Protocol 552
PhaseDrugRoute
InductionCyclophosphamide, vincristine, daunorubicinIV
Ara-C, methotrexateIT
PrednisonePO
ConsolidationAra-CIV or SC
6-thioguaninePO
MethotrexateIT
L-asparaginaseIM
BCNUIV
PhaseCycleDrugRoute
Maintenance*16-thioguaninePO
CyclophosphamideIV
2HydroxyureaPO
DaunorubicinIV
3MethotrexatePO
BCNUIV
4Ara-CIV or SC
VincristineIV
Source.—Children's Cancer Group.



Ara-C = cytarabine; BCNU = 1,3-bis(2-chloroethyl)-1-nitrosourea, or carmustine; IM = intramuscular; IT = intrathecal; IV = intravenous; PO = oral; SC = subcutaneous.



* A minimum of 5 repeated courses (total duration of therapy >18 mo) are noted. Each course of intrathecal methotrexate (day 0 of each course) consists of 4 cycles of rotating drug pairs that are administered every 2 weeks after blood counts have recovered.



Table 2. Therapy for Stage III and IV non–B-Cell Disease* According to BFM Protocol 86
PhasesDrugRoute
InductionPrednisone, 6-mercaptopurinePO
Vincristine, daunorubicin, cyclophosphamide, Ara-CIV
L-asparaginaseIM
MethotrexateIT
Consolidation6-mercaptopurinePO
Methotrexate with leucovorin rescueIV
MethotrexateIT
Re-inductionDexamethasone, 6-thioguaninePO
Vincristine, doxorubicin, cyclophosphamide, Ara-CIV
L-asparaginaseIM
MethotrexateIT
Maintenance†6-mercaptopurine, methotrexatePO
Source.—Berlin-Frankfurt-Munster Group.



Ara-C = cytarabine; IT = intrathecal; IV = intravenous; PO = oral; SC = subcutaneous.



* Diagnoses included lymphoblastic lymphoma of the T-cell or precursor B-cell type, immunoblastic T-cell lymphoma, and other peripheral T-cell lymphomas. Of note, patients with Ki-1+ anaplastic LCLs were not included.



† Continued until 24 months after diagnosis.



Table 3. Clinical Risk Groups in the International Trial for Patients With SNCCL (Children's Cancer Group study 5961)
Clinical GroupSubjects,



Estimated %



Definition
A10All resected stage I or abdominal stage II tumors
B65Unresected stage I or II tumor, stage III, tumor, or stage IV with no CNS involvement and < 25% marrow blasts
C25CNS involvement or >25% marrow blasts
Table 4. Standard Therapy for Subjects in the International Trial for Patients With SNCCL, Group A*
DrugRoute
PrednisonePO
Vincristine, cyclophosphamide, doxorubicinIV
Filgrastim (G-CSF), to enhance neutrophil recoverySC or IV
G-CSF = granulocyte colony-stimulating factor; IV = intravenous; PO = oral; SC = subcutaneous.



* See Table 3 for the definition of group A. All subjects received 2 cycles.



Table 5. Standard Therapy for Subjects in International Trial for Patients With SNCCL, Group B*
PhaseDrugRoute
ReductionPrednisonePO
Vincristine, cyclophosphamideIV
Methotrexate/hydrocortisoneIT
PhaseCyclesDrugRoute
Induction2, starting 7 d after reductionPrednisonePO
Vincristine, methotrexate with leucovorin rescue, cyclophosphamide, doxorubicinIV
Methotrexate/hydrocortisoneIT
Filgrastim (G-CSF)SC or IV
Consolidation2Methotrexate with leucovorin rescue, Ara-C
Methotrexate/hydrocortisone, Ara-C/hydrocortisone
Filgrastim (G-CSF)
Maintenance1PrednisonePO
Vincristine, methotrexate with leucovorin rescue, cyclophosphamide, doxorubicinIV
Methotrexate/hydrocortisoneIT
Ara-C = cytarabine; G-CSF = granulocyte colony-stimulating factor; IT = intrathecal; IV = intravenous; PO = oral, SC = subcutaneous.



* See Table 3 for the definition of group B.



Table 6. Standard Therapy for Subjects in International Trial for Patients With SNCCL, Group C*
PhaseDrugRoute
ReductionPrednisonePO
Vincristine, cyclophosphamideIV
Methotrexate/Ara-C/hydrocortisoneIT
Induction, cycle 1 starting 7 d after reductionPrednisonePO
Vincristine, high-dose methotrexate with leucovorin rescue, cyclophosphamide, doxorubicinIV
Methotrexate/Ara-C/hydrocortisoneIT
Filgrastim (G-CSF)SC or IV
Induction, cycle 2PrednisonePO
Vincristine, high-dose methotrexate with leucovorin rescue, cyclophosphamide, doxorubicinIV
Methotrexate/Ara-C/hydrocortisoneIT
Filgrastim (G-CSF)SC or IV
Consolidation, 2 cycles†High-dose Ara-C, etoposide (VP-16)IV
Filgrastim (G-CSF), days 7-21SC or IV
High-dose methotrexate with leucovorin rescueIV
Methotrexate/Ara-C/hydrocortisoneIT
Maintenance 1PrednisonePO
Vincristine, high-dose methotrexate with leucovorin rescue, cyclophosphamide, doxorubicinIV
Methotrexate/Ara-C/hydrocortisoneIT
Maintenance 2Ara-C, etoposide (VP-16)IT
Maintenance 3PrednisonePO
Vincristine, cyclophosphamide, doxorubicinIV
Maintenance 4Ara-C, etoposide (VP-16)IV
Ara-C = cytarabine; G-CSF = granulocyte colony-stimulating factor; IT = intrathecal; IV = intravenous; PO = oral, SC = subcutaneous.



* See Table 3 for the definition of group C.



† For patients with CNS involvement, during consolidation cycle 1 only.



Table 7. Prephase Therapy for Ki-1+ Anaplastic LCLs in All Patients According to the BFM-90 Protocol
DrugRoute
PrednisonePO
CyclophosphamideIV
Methotrexate/Ara-C/prednisoloneIT
Ara-C = cytarabine; IT = intrathecal; IV = intravenous; PO = oral.
Table 8. Subsequent Therapy for Ki-1+ Anaplastic LCLs According to the BFM-90 Protocol
CycleDrugRoute
AMethotrexate with leucovorin rescue, ifosfamide, etoposide (VP-16), Ara-CIV
Methotrexate/Ara-C/prednisoloneIT
BDexamethasonePO
Methotrexate with leucovorin rescue, Ara-C, doxorubicinIV
Methotrexate/Ara-C/prednisoloneIT
AADexamethasonePO
Vincristine, high-dose methotrexate with leucovorin rescue, ifosfamide, Ara-C, etoposide (VP-16)IV
Methotrexate/Ara-C/prednisoloneIT
BBDexamethasonePO
Vincristine, high-dose methotrexate with leucovorin rescue, cyclophosphamide, doxorubicinIV
Methotrexate/Ara-C/prednisoloneIT
CCDexamethasonePO
Vindesine, high-dose Ara-C, etoposide (VP-16)IV
Methotrexate/Ara-C/prednisoloneIT
Ara-C = cytarabine; IT = intrathecal; IV = intravenous; PO = oral.
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.