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Kobayashi R, Sunami S, Mitsui T, Nakazawa A, Koga Y, Mori T, Tanaka F, Ueyama JI, Osumi T, Fukano R, Ohki K, Sekimizu M, Mori T. Treatment of pediatric lymphoma in Japan: Current status and plans for the future. Pediatr Int 2015; 57:523-34. [PMID: 26096060 DOI: 10.1111/ped.12725] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/18/2015] [Accepted: 05/28/2015] [Indexed: 11/30/2022]
Abstract
Results of pediatric lymphoma treatment have improved markedly over the past 30 years. In Hodgkin's lymphoma, the 5 year event-free survival (EFS) was 81.5% in a retrospective study. In the ALB-NHL03 study, the 5 year EFS according to clinical stage in patients with lymphoblastic T-cell lymphoma (T-LBL) was 70.6% for stage III and 88.9% for stage IV. In mature B-cell lymphoma, the B-NHL03 study indicated that the 4 year EFS according to treatment group was 94% for group 1, 98% for group 2, 84% for group 3, and 78% for group 4. Moreover, the 2 year EFS rate was 81% in Japanese advanced stage patients based on the international ALCL99 study. Thus, EFS >80% was achieved in any subtype of pediatric lymphoma. With regard to refractory or recurrent lymphoma, however, treatment methods for improvement of the survival rate in these patients still need to be developed. Also the difference between child, and adolescent and young adult patients still needs to be clarified, and treatment protocols developed. Although lymphoma treatment does not greatly change according to country, it does differ between other countries and Japan for some subtypes of lymphoma. In particular, the results of treatment of stage III T-LBL in Japan are worse than those in the USA and Europe. The priority in future studies will be to collect data on these differences, and the reasons for these differences.
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Affiliation(s)
- Ryoji Kobayashi
- Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Shosuke Sunami
- Department of Pediatrics, Narita Red Cross Hospital, Narita, Japan
| | - Tetsuo Mitsui
- Department of Pediatrics, Yamagata University School of Medicine, Yamagata, Japan
| | - Atsuko Nakazawa
- Department of Pathology, Children's Cancer Cente, National Center for Child Health and Development, Tokyo, Japan
| | - Yuhki Koga
- Department of Pediatrics, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Takeshi Mori
- Department of Pediatrics, Kobe University School of Medicine, Kobe, Japan
| | - Fumiko Tanaka
- Department of Pediatrics, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Jun-ichi Ueyama
- Department of Multidisciplinary Internal Medicine, Division of Pediatrics and Perinatology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Tomoo Osumi
- Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Reiji Fukano
- Department of Pediatrics, National Hospital Organization Kyusyu Cancer Center, Fukuoka, Japan
| | - Kentaro Ohki
- Department of Hematology and Oncology, Gunma Children's Medical Center, Shibukawa, Japan
| | - Masahiro Sekimizu
- Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Tetsuya Mori
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
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Tsurusawa M, Mori T, Kikuchi A, Mitsui T, Sunami S, Kobayashi R, Takimoto T, Saito A, Watanabe T, Fujimoto J, Nakazawa A, Ohshima K, Horibe K. Improved treatment results of children with B-cell non-Hodgkin lymphoma: a report from the Japanese Pediatric Leukemia/Lymphoma Study Group B-NHL03 study. Pediatr Blood Cancer 2014; 61:1215-21. [PMID: 24523211 DOI: 10.1002/pbc.24975] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 01/16/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous Japanese studies of childhood B-cell non-Hodgkin lymphoma (B-NHL) have shown a favorable outcome, though the study size was too small to effectively assess the efficacy and safety of treatment for childhood B-NHL. PROCEDURE We performed a nation-wide prospective B-NHL03 study to assess the efficacy and safety of short-pulse intensive chemotherapy for children with B-NHL. They were stratified into four treatment groups according to disease stage, tumor resectability and bone marrow/CNS involvement: Group 1 with all resected stage I/II, Group 2 with non-resected stage I/II, Group 3 with stage III & CNS-negative stage IV, and Group 4 with CNS-positive stage IV & Burkitt leukemia. Treatment duration was 2 courses for Group 1, 4 courses for Group 2, and 6 courses for Groups 3 and 4, respectively. CNS irradiation was omitted in all patients. RESULTS The follow-up time ranged from 0.8 to 88 months, with a median of being 45 months. For 321 patients analyzed in this study, overall survival and event-free survival (EFS) at 4 years was 92.7% and 87.4%, respectively. The 4-year EFS according to treatment group were 94% for Group 1 (n = 17), 98% for Group 2 (n = 103), 84% for Group 3 (n = 111), and 78% for Group 4 (n = 90). There was no significant difference in outcome by histology. Therapy-related death occurred in three patients in remission. CONCLUSIONS Our nationwide large-scale study resulted in a cure rate above 90% with <1% toxic death in childhood B-NHL.
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Affiliation(s)
- Masahito Tsurusawa
- Advanced Medical Research Center, Aichi Medical University, Aichi, Japan
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Shimomura Y, Baba R, Watanabe A, Horikoshi Y, Asami K, Hyakuna N, Iwai A, Matsushita T, Yamaji K, Hori T, Tsurusawa M. Assessment of late cardiotoxicity of pirarubicin (THP) in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2011; 57:461-6. [PMID: 21298773 DOI: 10.1002/pbc.23012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 12/09/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pirarubicin (tetrahydropyranyl-adriamycin: THP) is a derivative of doxorubicin with reportedly less cardiotoxicity in adults. However no studies of cardiotoxicity in children treated with THP have been reported. This study was performed to assess the THP-induced cardiotoxicity for children with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS This study comprised 61 asymptomatic patients aged from 7.6 to 25.7 years old. Median follow-up time after completion of anthracycline treatment was 8.1 years (range: 1.7-12.5). The cumulative dose of THP ranged from 120 to 740 mg/m(2) with a median of 180 mg/m(2) . Patients underwent electrocardiogram (ECG), echocardiography, the 6-min walk test (6MWT), and measurements of serum brain natriuretic peptide (BNP) before and after exercise. RESULTS All subjects showed normal left ventricular function assessed by echocardiography. Ventricular premature contraction in Holter ECG and reduced exercise tolerance in the 6MWT were detected in 2/46 (3.3%) and 5/41(12.2%), respectively. Abnormal BNP levels were detected in 6/60 (10%) both before and after exercise. The cumulative dose of THP was significantly correlated with BNP levels after exercise (r = 0.27, P = 0.03), but not with any other cardiac measurements. Further analysis revealed that subjects with a high cumulative dose ≧300 mg/m(2) had significantly higher BNP levels after exercise compared with subjects with a low cumulative dose <300 mg/m(2) (P = 0.04). CONCLUSIONS No significant cardiac dysfunction was detected in long-term survivors who received THP treatment. The use of post-exercise BNP level to indicate high cardiotoxicity risk should be verified by further study.
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Affiliation(s)
- Yasuto Shimomura
- Department of Pediatrics, Aichi Medical University, Aichi-gun, Aichi-ken, Japan
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Current Awareness in Hematological Oncology. Hematol Oncol 2008. [DOI: 10.1002/hon.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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