Systemic Review And Clinical Study Of Childhood Non-hodgkin Lymphoma

Background: Non-Hodgkin lymphoma(NHL) of childhood is a diverse collection of malignant neoplasms derived from immature to mature lymphoid cells of either B-cell or T-cell origin?In developed countries, malignant lymphoma comprise the third most common group of malignancies in children after leukemias and brain tumors and account for 15% of all childhood malignancies in children younger than 20 years. Advances in histopathology, immunology, cytogenetics, and molecular biology have resulted in enormous progress in our understanding of the biology of NHL, which, consequently has led to more rational classification of these diseases. Progress in therapy of childhood NHL is one of the stunning success stories of the past 30 years. Obejctives: To review the diagnosis and treatment of childhood NHL and summarize the main problems in clinical. Then we study some cases that can not fully be diagnosed with mature B-cell acute lymphoblastic leukemia/non-Hodgkin lymphoma( B-ALL/NHL) and assess the safety and efficacy of the treatment protocol.Methods: Read literature about the diagnosis, classification and treatment progress of childhood NHL and summarise. Review the patients that cannot be clearly classified as the lymphoid neoplasms. We then began our study, from Feb 2003 to Dec 2012, 15 children that cannot be confirmed as mature B-cell acute lymphoblastic leukemia/non-Hodgkin lymphoma were diagnosed as mature B-cell acute lymphoblastic leukemia/ non-Hodgkin lymphoma possible( B-ALL/NHLp) and treated with SCMC-mature B-ALL/NHLp-2003 protocol. All of the clinical characteristics, therapeutic effects and long-term outcomes were analyzed. The statistics were done by SPSS 21.0.Result:Although the gradually thorough understanding and more reasonable classification of NHL have improved prognosis a lot, the treatment of intermediate, rare and relapsed or recurrent NHL is still a challenge. In our study, there were 15 B-ALL/NHLp patients. The median age at diagnosis was 10 years(1.5 to 14.4 year old). There were 10 male and 5 female children. Follow-up was updated to October 30, 2014. The median follow-up period was 91 months(50 months-139 months).The estimated 5 year event-free survival was 80%±10.3%.According to univariate analyses, increased LDH level(> 4-times the normal value),increased serum ferritin level(> 2-times the normal value) and without MRD were independent poor prognostic factors(?2 = 5.49?4.89?5.49,all P<0.05).Conclusion:Refinements in systemic chemotherapy based largely on staging system and risk stratification of NHL in children have led to high cure rates. Although the immunophenotype and specific molecular biology are mostly efficient for diagnosis, there are many problems to be solved in clinical, such as the cases which cannot be clearly classified and rare NHL subtypes. The future of improving outcome for children and adolescents with NHL must be biology driven focusing on monoclonal antibody and specific molecule/pathway targeting. Our study demonstrated that SCMC-mature B-NHL/ALLp-2003 protocol was feasible and safe for children with mature B-ALL/NHLp, but more cases needs to be analysed.