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Results and conclusions of the European Intergroup EURO-LB02 trial in children and adolescents with lymphoblastic lymphoma.

Journal article
Authors Eva Landmann
Birgit Burkhardt
Martin Zimmermann
Ulrike Meyer
Wilhelm Woessmann
Wolfram Klapper
Grazyna Wrobel
Angelo Rosolen
Marta Pillon
Gabriele Escherich
Andishe Attarbaschi
Auke Beishuizen
Karin Mellgren
Robert Wynn
Richard Ratei
Adriana Plesa
Martin Schrappe
Alfred Reiter
Christophe Bergeron
Catherine Patte
Yves Bertrand
Published in Haematologica
Volume 102
Issue 12
Pages 2086-2096
ISSN 1592-8721
Publication year 2017
Published at
Pages 2086-2096
Language en
Links dx.doi.org/10.3324/haematol.2015.13...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Pediatrics

Abstract

In the European Intergroup EURO-LB02 trial, children and adolescents with lymphoblastic lymphoma underwent the non-Hodgkin lymphoma Berlin-Frankfurt-Münster protocol without prophylactic cranial radiotherapy. The primary aims of this trial were to test whether replacing prednisone with dexamethasone during induction increases event-free survival in the subgroups with T-cell lymphoblastic lymphoma and whether therapy duration could be reduced from 24 to 18 months (factorial design, randomizations). These questions could not be answered due to premature closure of the trial. Here we report on the secondary aims of the trial: whether the results of the NHL-BFM90 study could be reproduced and evaluation of disease features and prognostic factors. Three hundred and nineteen patients (66 with precursor B-cell lymphoblastic lymphoma, 233 with T-cell lymphoblastic lymphoma, 12 with mixed phenotype, 8 not classifiable) were enrolled. In induction, 215 patients received prednisone and 104 patients received dexamethasone. The median follow-up was 6.8 years (range, 3.0-10.3). The 5-year event-free survival was 82±2% [12 toxic deaths, 5 secondary malignancies, 43 non-response/relapse (central nervous system n=9; all received prednisone during induction)]. The event-free survival rate was 80±5% for patients with precursor B-cell lymphoblastic lymphoma, 82±3% for those with T-cell lymphoblastic lymphoma, and 100% for patients with a mixed phenotype. During induction, significantly more grade III/IV toxicities were observed in patients receiving dexamethasone, resulting in significant treatment delays. The number of toxic deaths did not differ significantly. The only variable associated with outcome was performance status at diagnosis. The 90% event-free survival rate for patients with T-cell lymphoblastic lymphoma shown in study NHL-BFM90 was not replicated, mainly due to more toxic deaths and central nervous system relapses. Dexamethasone in induction may prevent central nervous system relapse more effectively than prednisone but produces a higher burden of toxicity. (#NCT00275106).

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