High treatment related mortality due to infection remains a major challenge in the management of high-grade B-cell Non-Hodgkin Lymphoma in children in developing countries: Experience from a tertiary cancer center in Eastern India
Background: Though the outcome of high-grade B-cell Non-Hodgkin Lymphoma (B-NHL) has improved significantly in recent years, but the treatment related toxicity is still high. Objectives: To study the demographic characteristics, outcome, and toxicity of FAB/LMB 96 backbone in pediatric patients with...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | Pediatric Hematology Oncology Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468124522001863 |
| _version_ | 1828310955226824704 |
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| author | Avijeet Kumar Mishra Shekhar Krishnan Arpita Bhattacharyya K.S. Reghu Anirban Das Sheetal Kulkarni Modi Parag Das Niharendu Ghara |
| author_facet | Avijeet Kumar Mishra Shekhar Krishnan Arpita Bhattacharyya K.S. Reghu Anirban Das Sheetal Kulkarni Modi Parag Das Niharendu Ghara |
| author_sort | Avijeet Kumar Mishra |
| collection | DOAJ |
| description | Background: Though the outcome of high-grade B-cell Non-Hodgkin Lymphoma (B-NHL) has improved significantly in recent years, but the treatment related toxicity is still high. Objectives: To study the demographic characteristics, outcome, and toxicity of FAB/LMB 96 backbone in pediatric patients with B-NHL. Materials and methods: A retrospective single center review of records of all patients <18 years of age with B-NHL treated on FAB/LMB 96 protocol at a tertiary cancer center between January 2011 to January 2020. Results: Out of the total 47 patients, there were 44 males and 3 females. Median age of presentation was 8 years 9 months. Total patients allocated to group A, B and C were 3 (6.4%), 29 (61.7%), and 15 (31.9%) respectively. With median follow up of 20 months, 2-year overall survival (OS) and event-free survival (EFS) for the whole cohort was 73.4% and 72.8%, respectively. The 2-year OS and EFS for group A, B and C were 100%, 82.6%, 45.7% and 100%, 81.9%, 45.0% respectively. There were total 13 deaths out of which 8 (61.5%) were treatment related mortality (TRM). Almost all of the TRM (7/8; 83.3%) were due to multi-drug resistant organism (MDRO) sepsis. Conclusions: This study shows outcomes comparable to other centers in low and intermediate risk patients. Children with high-risk disease however have poor outcome due to high MDRO sepsis related mortality, a finding consistently shared across other centers in resource limited settings. This emphasizes on the need for newer strategies in this group of patients probably as an InPOG prospective multicenter trial including immunotherapy and chemotherapy backbone according to local practicalities. In contrast to the recently published Indian study, we did not find excess toxic deaths in our cohort of patients receiving rituximab. |
| first_indexed | 2024-04-13T15:51:40Z |
| format | Article |
| id | doaj.art-27bc8e924cf8412bbf9287344dce9028 |
| institution | Directory Open Access Journal |
| issn | 2468-1245 |
| language | English |
| last_indexed | 2024-04-13T15:51:40Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Pediatric Hematology Oncology Journal |
| spelling | doaj.art-27bc8e924cf8412bbf9287344dce90282022-12-22T02:40:49ZengElsevierPediatric Hematology Oncology Journal2468-12452022-06-01725460High treatment related mortality due to infection remains a major challenge in the management of high-grade B-cell Non-Hodgkin Lymphoma in children in developing countries: Experience from a tertiary cancer center in Eastern IndiaAvijeet Kumar Mishra0Shekhar Krishnan1Arpita Bhattacharyya2K.S. Reghu3Anirban Das4Sheetal Kulkarni Modi5Parag Das6Niharendu Ghara7Department of Pediatric Hematology/Oncology, Tata Translational Research Center, IndiaDepartment of Pediatric Hematology/Oncology, Tata Translational Research Center, India; Tata Medical Center, Kolkata, IndiaDepartment of Pediatric Hematology/Oncology, Tata Translational Research Center, IndiaDepartment of Pediatric Hematology/Oncology, Tata Translational Research Center, IndiaDepartment of Pediatric Hematology/Oncology, Tata Translational Research Center, IndiaDepartment of Pediatric Hematology/Oncology, Tata Translational Research Center, IndiaTata Medical Center, Kolkata, IndiaDepartment of Pediatric Hematology/Oncology, Tata Translational Research Center, India; Corresponding author. Pediatric Hematology/Oncology, Tata Medical Center, 14, Major Arterial Road (EW), Rajarhat, New Town, Kolkata 700160, India.;Background: Though the outcome of high-grade B-cell Non-Hodgkin Lymphoma (B-NHL) has improved significantly in recent years, but the treatment related toxicity is still high. Objectives: To study the demographic characteristics, outcome, and toxicity of FAB/LMB 96 backbone in pediatric patients with B-NHL. Materials and methods: A retrospective single center review of records of all patients <18 years of age with B-NHL treated on FAB/LMB 96 protocol at a tertiary cancer center between January 2011 to January 2020. Results: Out of the total 47 patients, there were 44 males and 3 females. Median age of presentation was 8 years 9 months. Total patients allocated to group A, B and C were 3 (6.4%), 29 (61.7%), and 15 (31.9%) respectively. With median follow up of 20 months, 2-year overall survival (OS) and event-free survival (EFS) for the whole cohort was 73.4% and 72.8%, respectively. The 2-year OS and EFS for group A, B and C were 100%, 82.6%, 45.7% and 100%, 81.9%, 45.0% respectively. There were total 13 deaths out of which 8 (61.5%) were treatment related mortality (TRM). Almost all of the TRM (7/8; 83.3%) were due to multi-drug resistant organism (MDRO) sepsis. Conclusions: This study shows outcomes comparable to other centers in low and intermediate risk patients. Children with high-risk disease however have poor outcome due to high MDRO sepsis related mortality, a finding consistently shared across other centers in resource limited settings. This emphasizes on the need for newer strategies in this group of patients probably as an InPOG prospective multicenter trial including immunotherapy and chemotherapy backbone according to local practicalities. In contrast to the recently published Indian study, we did not find excess toxic deaths in our cohort of patients receiving rituximab.http://www.sciencedirect.com/science/article/pii/S2468124522001863B-NHLFAB/LMB 96TRMMDRO sepsisIndiaResource limited |
| spellingShingle | Avijeet Kumar Mishra Shekhar Krishnan Arpita Bhattacharyya K.S. Reghu Anirban Das Sheetal Kulkarni Modi Parag Das Niharendu Ghara High treatment related mortality due to infection remains a major challenge in the management of high-grade B-cell Non-Hodgkin Lymphoma in children in developing countries: Experience from a tertiary cancer center in Eastern India Pediatric Hematology Oncology Journal B-NHL FAB/LMB 96 TRM MDRO sepsis India Resource limited |
| title | High treatment related mortality due to infection remains a major challenge in the management of high-grade B-cell Non-Hodgkin Lymphoma in children in developing countries: Experience from a tertiary cancer center in Eastern India |
| title_full | High treatment related mortality due to infection remains a major challenge in the management of high-grade B-cell Non-Hodgkin Lymphoma in children in developing countries: Experience from a tertiary cancer center in Eastern India |
| title_fullStr | High treatment related mortality due to infection remains a major challenge in the management of high-grade B-cell Non-Hodgkin Lymphoma in children in developing countries: Experience from a tertiary cancer center in Eastern India |
| title_full_unstemmed | High treatment related mortality due to infection remains a major challenge in the management of high-grade B-cell Non-Hodgkin Lymphoma in children in developing countries: Experience from a tertiary cancer center in Eastern India |
| title_short | High treatment related mortality due to infection remains a major challenge in the management of high-grade B-cell Non-Hodgkin Lymphoma in children in developing countries: Experience from a tertiary cancer center in Eastern India |
| title_sort | high treatment related mortality due to infection remains a major challenge in the management of high grade b cell non hodgkin lymphoma in children in developing countries experience from a tertiary cancer center in eastern india |
| topic | B-NHL FAB/LMB 96 TRM MDRO sepsis India Resource limited |
| url | http://www.sciencedirect.com/science/article/pii/S2468124522001863 |
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