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Small noncleaved cell lymphoma and leukemia in adults. A retrospective
study of 65 adults treated with the LMB pediatric protocols
C Soussain, C Patte, M Ostronoff, A Delmer, F Rigal-Huguet, N Cambier, PY Leprise, S Francois, P Cony-Makhoul and JL Harousseau
Institut Gustave Roussy, Villejuif, France.
In France, more than 80% of children with Burkitt's lymphoma or Burkitt's
leukemia (ALL3) are now cured with the LMB (B-cell non- Hodgkin's lymphoma
and B-ALL) protocols of the Societe Francaise d'Oncologie Pediatrique, but
so far, poor results have been obtained in the few adult studies available.
We have analyzed the experience with LMB protocols in adult patients. This
retrospective study involved 65 adult patients with small noncleaved cell
lymphoma or ALL3 treated with the LMB protocols. They were 17 to 65 years
old and not previously treated. Human immunodeficiency virus-infected
patients were excluded. The diagnoses were made between September 1984 and
August 1991. According to the Murphy classification, 12 patients (18%) had
stage I or II disease, 25 (38%), stage III disease; 4 (6%), stage IV
disease; and 24 (37%), ALL3 (> or = 25% blasts). According to the Ann
Arbor classification, 9 patients had stage I disease; 8 patients, stage II;
5 patients, stage III; 21 patients, stage IV disease; and 22 patients, ALL
(> or = 30% blasts). Twelve patients had central nervous system (CNS)
involvement before treatment. Thirty-nine patients were treated according
to the LMB 84 protocol scheme; 14 according to the LMB 86 protocol, and 12
patients received the LMB 84 induction courses followed by the LMB 86
consolidation courses. Three patients underwent bone marrow transplantation
(BMT) while in second complete remission (CR) and 3 others had refractory
disease. There were some protocol violations caused by empirical medical
decisions: local irradiation was performed in 4 patients, 2 patients
received prophylactic radiation to the brain that was not specified in the
protocol, 13 patients underwent BMT in first CR, and methotrexate doses
were modified in 10 patients. Fifty-eight patients (89%) achieved a CR.
There were four (6%) primary induction treatment failures, and three (4%)
early treatment-related deaths. Eight patients relapsed between 2 and 30
months after CR (median, 4.7 months). Forty-seven patients are alive in CR
(45 first CR, 2 second CR) with a median follow-up of 57 months (24 to 93
months). There were five toxicity-related deaths among patients in CR
including four BMT-related deaths and five deaths caused by refractory
relapses. One patient died in CR at 62 months of rectal cancer. The 3- year
overall survival rate is 74% (SE = 5). According to the stages in the
Murphy classification, the 3-year survival rates are stages I and II, 100%;
stage III, 80% (SE = 7); and stage IV and ALL, 57% (SE = 8). Seven of 12
patients with initial CNS disease are alive with a median survival of 56
months.(ABSTRACT TRUNCATED AT 400 WORDS)
Volume 85,
Issue 3,
pp. 664-674,
02/01/1995
Copyright © 1995 by The American Society of Hematology
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