Treatment of B-cell Acute Lymphoblastic Leukemia and B-cell Lymphoma / 대한소아혈액종양학회지

ABSTRACT

PURPOSE: We report here the improved survival rate of B-cell acute lymphoblstic leukemia (B-ALL) and B-cell non-Hodgkin's lymphoma (B-NHL) treated with a short, intensive multiagent chemotherapy and the treatment related toxicities and complications. METHODS: From Oct. 1997 to Apr. 2002, 10 patients were enrolled. Patients were classified into three groups (Group A, B, C) according to tumor burden and were treated with CCG 5961, UKCCSG 9600, and LMB96 protocol. Induction chemotherapy included cyclophsophamide, vincristine, prednisolone, doxorubicin and high dose (HD) methotrexate (COPADM). Consolidation chemotherapy included HD methotrexate, HD cytarabine and etoposide (CYM; group B, CYVE; group C). In one patient, HD chemotherapy with stem cell rescue was used because residual disease was detected after consolidation chemotheapy. RESULTS: Four patients were B-ALL and six patients were B-NHL (A; 1, B; 2, C; 7). Regimen was changed in 1 patient because of residual disease (B--treatment duration was 7 months (range 1~9 months) and median follow-up duration was 35 months (range 1~54 months). Acute tumor lysis syndrome prompted hemodialysis in 4 patients. Neutropenia with fever and uncontrolled severe infection were accompanied in 87% and 27%. Thirty-nine percent of patients were suffered from stomatitis above grade II toxicity. There was a bone marrow and bone relapse in one patient within four months after off therapy. Overall survival was 77% in all patients, 72% in stage III, IV B-NHL and B-ALL.

CONCLUSION:

This study confirms the effectiveness of short, intensive multiagent chemotherapy and we suggest early detection and management of toxic complication is the cornerstone of successful therapy.