Non-Hodgkin lymphoma, pediatric

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 David Noyd, MD, MPH
University of Washington
Seattle, WA, USA
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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


Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

NCCN

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

Glucocorticoid therapy

CNS therapy, prophylaxis

7-day course

Subsequent treatment

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 NCT00002757

Untreated, induction

COPADM

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

Regimen variant #1

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

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

Preceding treatment

Chemotherapy

Glucocorticoid therapy

Supportive therapy

CNS therapy, prophylaxis

One course

Subsequent treatment

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


Regimen variant #2

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Minard-Colin et al. 2020 (Inter-B-NHL Ritux 2010) 2011-2015 Phase 3 (C) R-COPADM Inferior OS

Note: Cycle 2 should start as soon as peripheral blood counts have recovered (ANC approximately 1000/uL and platelets approximately 100 x 109/L), which is usually days 18 to 21. The main difference between this and the above variant is the capped vincristine and the tapering of the steroids.

Preceding treatment

  • Inter-B-NHL Ritux 2010, high-risk: COP pre-phase

Chemotherapy

Glucocorticoid therapy

Supportive therapy

  • Leucovorin (Folinic acid) 15 mg/m2 PO every 6 hours until MTX level less than 0.15, beginning 24 hours after the start of the HD-MTX infusion

CNS therapy, prophylaxis

16- to 21-day cycle for 2 cycles (see note)

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 NCT00002757
  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 contains dosing details in supplement PubMed NCT01516580

R-COPADM

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

Regimen

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 (secondary endpoint)
OS36: 95.1% vs 87.3%
(HR 0.36, 95% CI 0.16-0.82)

Superior EFS (primary endpoint)
EFS36: 93.9% vs 82.3%
(HR 0.32, 95% CI 0.15-0.66)

Note: Cycle 2 should start as soon as peripheral blood counts have recovered (ANC approximately 1000/uL and platelets approximately 100 x 109/L), which is usually days 18 to 21.

Preceding treatment

  • Inter-B-NHL Ritux 2010, high-risk: COP pre-phase

Targeted therapy

Chemotherapy

Glucocorticoid therapy

Supportive therapy

  • Leucovorin (Folinic acid) 15 mg/m2 PO every 6 hours until MTX level less than 0.15, beginning 24 hours after the start of the HD-MTX infusion

CNS therapy, prophylaxis

16- to 21-day cycle for 2 cycles (see note)

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 dosing details in supplement PubMed NCT01516580
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