Standard Treatment Options
Treatment Options Under Clinical Evaluation
Current Clinical Trials

For recurrent or refractory B-lineage non-Hodgkin lymphoma (NHL) or lymphoblastic lymphoma, survival is generally 10% to 20%.[1-5] For recurrent or refractory anaplastic large cell lymphoma, as many as 60% of patients can achieve long-term survival.[3] There is no current standard treatment option for patients with recurrent or progressive disease. The first goal is to try to control the disease. A Children’s Cancer Group (CCG) study (CCG-5912) was able to achieve complete remission in 40% of NHL patients.[6] Radiation therapy may have a role in treating patients who have not had a complete response to therapy. If remission can be achieved, high-dose therapy and stem cell transplantation are usually pursued. The benefit of autologous versus allogeneic stem cell transplantation is unclear.[3,7-11] All patients with primary refractory or relapsed NHL should be considered for clinical trials.

• Allogeneic or autologous bone marrow transplantation.[3,7-11]



• DECAL: dexamethasone, etoposide, cisplatin, cytarabine, and L-asparaginase.[6]



• ICE: ifosfamide, carboplatin, and etoposide.[12,13]

• ANHL0121:[14] Rituximab, ifosfamide, carboplatin, and etoposide (mature B-cell only). This trial (COG-ANHL0121) is closed to new patient accrual.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent childhood non-Hodgkin lymphoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References

1. Cairo MS, Sposto R, Perkins SL, et al.: Burkitt's and Burkitt-like lymphoma in children and adolescents: a review of the Children's Cancer Group experience. Br J Haematol 120 (4): 660-70, 2003.  [PUBMED Abstract]
   
   
2. Atra A, Gerrard M, Hobson R, et al.: Outcome of relapsed or refractory childhood B-cell acute lymphoblastic leukaemia and B-cell non-Hodgkin's lymphoma treated with the UKCCSG 9003/9002 protocols. Br J Haematol 112 (4): 965-8, 2001.  [PUBMED Abstract]
   
   
3. Attarbaschi A, Dworzak M, Steiner M, et al.: Outcome of children with primary resistant or relapsed non-Hodgkin lymphoma and mature B-cell leukemia after intensive first-line treatment: a population-based analysis of the Austrian Cooperative Study Group. Pediatr Blood Cancer 44 (1): 70-6, 2005.  [PUBMED Abstract]
   
   
4. Cairo MS, Sposto R, Hoover-Regan M, et al.: Childhood and adolescent large-cell lymphoma (LCL): a review of the Children's Cancer Group experience. Am J Hematol 72 (1): 53-63, 2003.  [PUBMED Abstract]
   
   
5. Cairo MS, Gerrard M, Sposto R, et al.: Results of a randomized international study of high-risk central nervous system B non-Hodgkin lymphoma and B acute lymphoblastic leukemia in children and adolescents. Blood 109 (7): 2736-43, 2007.  [PUBMED Abstract]
   
   
6. Kobrinsky NL, Sposto R, Shah NR, et al.: Outcomes of treatment of children and adolescents with recurrent non-Hodgkin's lymphoma and Hodgkin's disease with dexamethasone, etoposide, cisplatin, cytarabine, and l-asparaginase, maintenance chemotherapy, and transplantation: Children's Cancer Group Study CCG-5912. J Clin Oncol 19 (9): 2390-6, 2001.  [PUBMED Abstract]
   
   
7. Levine JE, Harris RE, Loberiza FR Jr, et al.: A comparison of allogeneic and autologous bone marrow transplantation for lymphoblastic lymphoma. Blood 101 (7): 2476-82, 2003.  [PUBMED Abstract]
   
   
8. Ladenstein R, Pearce R, Hartmann O, et al.: High-dose chemotherapy with autologous bone marrow rescue in children with poor-risk Burkitt's lymphoma: a report from the European Lymphoma Bone Marrow Transplantation Registry. Blood 90 (8): 2921-30, 1997.  [PUBMED Abstract]
   
   
9. Sandlund JT, Bowman L, Heslop HE, et al.: Intensive chemotherapy with hematopoietic stem-cell support for children with recurrent or refractory NHL. Cytotherapy 4 (3): 253-8, 2002.  [PUBMED Abstract]
   
   
10. Gordon BG, Warkentin PI, Weisenburger DD, et al.: Bone marrow transplantation for peripheral T-cell lymphoma in children and adolescents. Blood 80 (11): 2938-42, 1992.  [PUBMED Abstract]
    
    
11. Woessmann W, Peters C, Lenhard M, et al.: Allogeneic haematopoietic stem cell transplantation in relapsed or refractory anaplastic large cell lymphoma of children and adolescents--a Berlin-Frankfurt-Münster group report. Br J Haematol 133 (2): 176-82, 2006.  [PUBMED Abstract]
    
    
12. Cairo MS, Shen V, Krailo MD, et al.: Prospective randomized trial between two doses of granulocyte colony-stimulating factor after ifosfamide, carboplatin, and etoposide in children with recurrent or refractory solid tumors: a children's cancer group report. J Pediatr Hematol Oncol 23 (1): 30-8, 2001.  [PUBMED Abstract]
    
    
13. Kung FH, Harris MB, Krischer JP: Ifosfamide/carboplatin/etoposide (ICE), an effective salvaging therapy for recurrent malignant non-Hodgkin lymphoma of childhood: a Pediatric Oncology Group phase II study. Med Pediatr Oncol 32 (3): 225-6, 1999.  [PUBMED Abstract]
    
    
14. Griffin TC, Children's Oncology Group: Phase II Study of Ifosfamide, Carboplatin, and Etoposide Combined With Rituximab in Pediatric Patients With Recurrent or Refractory B-Cell Non-Hodgkin's Lymphoma or Acute Lymphoblastic Leukemia, COG-ANHL0121, Clinical trial, Completed.  [PDQ Clinical Trial]
    
    

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