Reducing chemotherapy dose intensity by 25% and adding rituximab improves survival in pediatric mature B‐cell non‐Hodgkin lymphoma in LMIC setting

Abstract

AbstractBackground and objectivesPediatric B‐cell non‐Hodgkin lymphomas (NHL) in low‐ and middle‐income countries (LMICs) have historically had inferior outcomes due to higher treatment‐related mortality (TRM) and relapses. To address this issue, we evaluated the impact of reducing chemotherapy dose intensity by 25% and adding rituximab on outcomes in pediatric B‐NHL.Patients and methodsPatients, less than 18 years of age with group B and C disease as per the Lymphome Malin de Burkitt (LMB) risk stratification were enrolled between September 2017 and October 2022. The LMB‐89 protocol, with a 25% reduction in all chemotherapy doses and the addition of rituximab, was administered. The response was assessed using positron emission tomography with computed tomography (PET/CT) after four cycles of chemotherapy (interim) and at the end of treatment.ResultsThe study included 25 patients with a median age of 6.9 years, among whom 20 (80%) were males. Twenty patients had group B and five had group C disease. Complete metabolic response (CMR) was achieved by 22/25 (88%) patients, and three (12%) achieved partial metabolic response (PMR) in the interim PET/CT. At the end of treatment, 22/24 (92%) patients achieved CMR, one had PMR, and one had progressive disease. The median follow‐up was 45 months (range: 3–71 months). The 4‐year event‐free survival and overall survival were 88% and 92%, respectively. There were two deaths, one due to disease progression and the other due to sepsis.ConclusionOur study demonstrates a significant improvement in outcomes in pediatric B‐NHL compared to previous reports from LMICs, achieved through a 25% reduction in chemotherapy dose intensity and the addition of rituximab.