Treatment of relapsed/refractory paediatric aggressive B-cell non-Hodgkin lymphoma

Br J Haematol. 2020 Jun;189(5):826-843. doi: 10.1111/bjh.16461. Epub 2020 Mar 6.

Abstract

Aggressive B-cell non-Hodgkin lymphoma (B-NHL) accounts for ≈60% of NHL in children/adolescents. In newly diagnosed Burkitt lymphoma and diffuse large B-cell lymphoma, short intensive multiagent chemotherapy is associated with a five-year event-free survival of around 90%. Very few children/adolescents with aggressive B-NHL show a relapsed/refractory (r/r) disease. The outcome is poor, with cure rates <30%, and there is no standard of care. Rituximab-containing salvage regimens may provide a complete/partial response in 60-70% of cases. However, long-term survival is <10% for non-transplanted patients. Autologous or allogeneic haematopoietic stem cell transplant is, nowadays, the best option for responding patients, with survival rates around 50%. The benefit of autologous versus allogeneic HSCT is not clear. Numerous novel therapies for r/r B-NHL are currently being tested in adults, including next-generation monoclonal antibodies, novel cellular therapy strategies and therapies directed against new targets. Some are under investigation also in children/adolescents, with promising preliminary results.

Keywords: children/adolescents; novel therapies; relapsed/refractory B-cell lymphoma; salvage treatment.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Central Nervous System Neoplasms / drug therapy
  • Central Nervous System Neoplasms / pathology
  • Central Nervous System Neoplasms / radiotherapy
  • Child
  • Combined Modality Therapy
  • Cranial Irradiation
  • Female
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Immunotherapy / methods
  • Kaplan-Meier Estimate
  • Lymphoma, B-Cell / drug therapy
  • Lymphoma, B-Cell / pathology
  • Lymphoma, B-Cell / radiotherapy
  • Lymphoma, B-Cell / therapy*
  • Male
  • Mediastinal Neoplasms / drug therapy
  • Mediastinal Neoplasms / therapy
  • Prognosis
  • Recurrence
  • Risk Factors
  • Salvage Therapy*
  • Therapies, Investigational
  • Treatment Outcome
  • Young Adult