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Table 5. Standard Treatment Options for High-Stage B-cell NHL

 Stratum Disease Manifestations Treatment 
ALL = acute lymphoblastic leukemia; BFM = Berlin-Frankfurt-Munster; CNS = central nervous system; LDH = lactate dehydrogenase; NHL= non-Hodgkin lymphoma.
FAB/LMB-96 International Study COG-C5961 (FAB/LMB-96) [2,3]BMultiple extra-abdominal sitesPrephase + four cycles of chemotherapy (reduced intensity arm) [2]
Nonresected stage I and II, III, IV
Marrow <25% blasts
No CNS disease
CMature B-cell ALL (>25% blasts in marrow) and/or CNS diseasePrephase + eight cycles of chemotherapy (full intensity arm) [3]
BFM Group [1,5]R2Nonresected stage I/II and stage III with LDH <500 IU/LPrephase + four cycles of chemotherapy (4 h methotrexate infusion) [1]
R3Stage III with LDH 500–999 IU/LPrephase + five cycles of chemotherapy (24 h methotrexate infusion) [1]
Stage IV, B-cell ALL (>25% blasts) and LDH <1,000 IU/L
No CNS disease
R4Stage III, IV, B-cell ALL with LDH >1,000 IU/LPrephase + six cycles of chemotherapy (24 h methotrexate infusion) [1]
Any CNS disease

References

  1. Woessmann W, Seidemann K, Mann G, et al.: 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 105 (3): 948-58, 2005.  [PUBMED Abstract]

  2. 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 109 (7): 2773-80, 2007.  [PUBMED Abstract]

  3. 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 109 (7): 2736-43, 2007.  [PUBMED Abstract]

  4. Reiter A, Schrappe M, Tiemann M, et al.: Improved treatment results in childhood B-cell neoplasms with tailored intensification of therapy: A report of the Berlin-Frankfurt-Münster Group Trial NHL-BFM 90. Blood 94 (10): 3294-306, 1999.  [PUBMED Abstract]