Non-Hodgkin lymphoma, pediatric

Section editor
	David Noyd, MD, MPH University of Oklahoma Oklahoma City, OK LinkedIn

This page contains studies that were specific to pediatric populations, who are generally treated based on risk-stratification, not on the underlying histology. See individual trials for inclusion criteria.

3 regimens on this page 3 variants on this page

Untreated, pre-phase

CVP

CVP: Cyclophosphamide, Vincristine, Prednisone
COP: Cyclophosphamide, Oncovin (Vincristine), Prednisone

Regimen

Study	Dates of enrollment	Evidence
Patte et al. 2007 (FAB/LMB96)	1996-2001	Non-randomized part of phase 3 RCT

Chemotherapy

• Cyclophosphamide (Cytoxan) 300 mg/m² IV once on day 1
• Vincristine (Oncovin) 1 mg/m² IV once on day 1

Glucocorticoid therapy

• Prednisone (Sterapred) 60 mg/m²/day IV or PO on days 1 to 7

CNS therapy, prophylaxis

• Methotrexate (MTX) (dose not specified) IT once on day 1

7-day course

Subsequent treatment

• COPADM induction

References

1. FAB/LMB96: Patte C, Auperin A, Gerrard M, Michon J, Pinkerton R, Sposto R, Weston C, Raphael M, Perkins SL, McCarthy K, Cairo MS; FAB/LMB96 International Study Committee. 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. 2007 Apr 1;109(7):2773-80. link to original article link to PMC article contains dosing details in manuscript PubMed Clinical Trial Registry

Untreated, induction

COPADM

COPADM: Cyclophosphamide, Oncovin (Vincristine), Prednisone, ADriamycin (Doxorubicin), Methotrexate

Protocol

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Patte et al. 2007 (FAB/LMB96)	1996-2001	Non-randomized part of phase 3 RCT
Minard-Colin et al. 2020 (Inter-B-NHL Ritux 2010)	2011-2015	Phase 3 (C)	R-COPADM	Inferior OS

Note: It is not clear from Patte et al. 2007 whether the cyclophosphamide was fractionated.

Preceding treatment

• COP pre-phase

Chemotherapy

• Cyclophosphamide (Cytoxan) 250 mg/m² IV twice per day on days 2 to 4 (total dose: 1500 mg/m²)
• Vincristine (Oncovin) 2 mg/m² IV once on day 1
• Doxorubicin (Adriamycin) 60 mg/m² IV once on day 2
• Methotrexate (MTX) 3000 mg/m² IV over 3 hours once on day 1

Glucocorticoid therapy

• Prednisone (Sterapred) 60 mg/m²/day IV or PO on days 1 to 7

Supportive therapy

• Folinic acid (Leucovorin)

CNS therapy, prophylaxis

• Methotrexate (MTX) (dose not specified) IT once per day on days 2 & 6

One course

Subsequent treatment

• COPADM re-induction; reduced-dose versus COPADM re-induction; standard-dose

References

1. FAB/LMB96: Patte C, Auperin A, Gerrard M, Michon J, Pinkerton R, Sposto R, Weston C, Raphael M, Perkins SL, McCarthy K, Cairo MS; FAB/LMB96 International Study Committee. 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. 2007 Apr 1;109(7):2773-80. link to original article link to PMC article contains dosing details in manuscript PubMed Clinical Trial Registry
2. Inter-B-NHL Ritux 2010: Minard-Colin V, Aupérin A, Pillon M, Burke GAA, Barkauskas DA, Wheatley K, Delgado RF, Alexander S, Uyttebroeck A, Bollard CM, Zsiros J, Csoka M, Kazanowska B, Chiang AK, Miles RR, Wotherspoon A, Adamson PC, Vassal G, Patte C, Gross TG; European Intergroup for Childhood Non-Hodgkin Lymphoma; Children’s Oncology Group. Rituximab for High-Risk, Mature B-Cell Non-Hodgkin's Lymphoma in Children. N Engl J Med. 2020 Jun 4;382(23):2207-2219. link to original article link to PMC article PubMed Clinical Trial Registry

R-COPADM

R-COPADM: Rituximab, Cyclophosphamide, Oncovin (Vincristine), Prednisone, ADriamycin (Doxorubicin), Methotrexate

Protocol

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Minard-Colin et al. 2020 (Inter-B-NHL Ritux 2010)	2011-2015	Phase 3 (E-RT-esc)	COPADM	Superior OS OS36: 95.1% vs 87.3% (HR 0.36, 95% CI 0.16-0.82)

Note: Only partial dosing information is available in the manuscript/supplement; dosing here is primarily based on FAB/LMB96.

Preceding treatment

• COP pre-phase

Targeted therapy

• Rituximab (Rituxan) 375 mg/m² IV once per day on days -2 & 1

Chemotherapy

• Cyclophosphamide (Cytoxan) 250 mg/m² IV twice per day on days 2 to 4 (total dose: 1500 mg/m²)
• Vincristine (Oncovin) 2 mg/m² IV once on day 1
• Doxorubicin (Adriamycin) 60 mg/m² IV once on day 2
• Methotrexate (MTX) 3000 mg/m² IV over 3 hours once on day 1

Glucocorticoid therapy

• Prednisone (Sterapred) 60 mg/m²/day IV or PO on days 1 to 7

Supportive therapy

• Folinic acid (Leucovorin)

CNS therapy, prophylaxis

• Methotrexate (MTX) (dose not specified) IT once per day on days 2 & 6

One course

Subsequent treatment

• R-COPADM re-induction

References

1. Inter-B-NHL Ritux 2010: Minard-Colin V, Aupérin A, Pillon M, Burke GAA, Barkauskas DA, Wheatley K, Delgado RF, Alexander S, Uyttebroeck A, Bollard CM, Zsiros J, Csoka M, Kazanowska B, Chiang AK, Miles RR, Wotherspoon A, Adamson PC, Vassal G, Patte C, Gross TG; European Intergroup for Childhood Non-Hodgkin Lymphoma; Children’s Oncology Group. Rituximab for High-Risk, Mature B-Cell Non-Hodgkin's Lymphoma in Children. N Engl J Med. 2020 Jun 4;382(23):2207-2219. link to original article link to PMC article contains partial protocol PubMed Clinical Trial Registry