22 June 2020

Positive results have been seen in a trial of an immunotherapy drug for young people with aggressive non-Hodgkin’s lymphoma. The study tested the addition of rituximab to standard chemotherapy for advanced mature B-cell non-Hodgkin’s lymphoma in children and adolescents.

Although the cure rate for Burkitt’s lymphoma in children has risen from 30% in the 1980s to above 85%, the mortality rate remains at 15% with the standard LMB chemotherapy.

The international phase 3 trial was jointly coordinated by Dr Véronique Minard-Colin of the Gustave Roussy Institute in Paris, and Dr Thomas Gross at Children’s Hopsital Colorado, USA. The results were published on 4th June in the New England Journal of Medicine.

A group of 328 participants under the age of 18 were given either six doses of rituximab with standard LMB chemotherapy, or chemotherapy on its own. Most of the children and adolescents (86%) had Burkitt’s lymphoma.

Event-free survival after three years was 93.9% with rituximab plus chemotherapy, and 82.3% with chemotherapy alone, a hazard ratio reduction of 68%. Overall survival at three years was 95.1% in the rituximab-chemotherapy group and 87.3% in the chemotherapy-alone group.

Treatment-related mortality was equal in both groups, three patients in each. But rates of severe adverse events (grade 4 or higher) were 33.3% in the combined treatment group and 24.2% in the chemotherapy-alone group.

The authors write that the new regime “markedly prolonged event-free survival and overall survival”, but added that it “was associated with a higher incidence of hypogammaglobulinaemia and, potentially, more episodes of infection”.

Dr Minard-Colin said: “With a three-year survival rate exceeding 95%, these results are outstanding. This study changes the international treatment bench-mark in young patients with advanced B-cell non-Hodgkin lymphoma.”

Source: Minard-Colin V, Aupérin A, Pillon M, Burke GAA, Barkauskas DA, Wheatley K, Delgado RF, Alexander S, Uyttebroeck A, Bollard CM, Zsiros J, Csoka M, Kazanowska B, Chiang AK, Miles RR, Wotherspoon A, Adamson PC, Vassal G, Patte C, Gross TG; European Intergroup for Childhood Non-Hodgkin Lymphoma; Children’s Oncology Group. (2020) “Rituximab for High-Risk, Mature B-Cell Non-Hodgkin’s Lymphoma in Children”, New England Journal of Medicine, doi: 10.1056/NEJMoa1915315


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