Prognostic factors, lines of treatment, and outcome of relapsed pediatric lymphoblastic lymphoma in Children Cancer Hospital Egypt

Document Type : Original Article


1 Department of oncology, Beni-Suef University, Beni-Suef, Egypt. Depaetment of pediatric oncology, Children Cancer Hospital Egypt

2 department of pediatric oncology, Children's cancer hospital Egypt

3 Department of Clinical Pathology, National Cancer Institute (NCI), Cairo University, Egypt Department of Clinical Pathology, Children’s Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt

4 Department of Pathology, National Cancer Institute, Cairo University, Egypt Department of Pathology, Children Cancer Hospital Egypt, Egypt

5 Department of Radiodiagnosis, National Cancer Institute, Cairo University, Egypt Department of Radiodiagnosis, Children Cancer Hospital Egypt, Egypt

6 Department of Clinical Research, Children Cancer Hospital Egypt, Cairo, Egypt

7 Department of Pediatric Oncology, National Cancer Institute Cairo University. Department of Pediatric Oncology Children Cancer Hospital Egypt 57357


Background: Pediatric patients with relapsed lymphoblastic lymphoma (LBL) have poor prognoses [1]. This study aims to evaluate the prognostic factors, chemotherapy used, the role of HSCT, and the survival outcome of relapsed pediatric LBL. This retrospective study included 38 relapsed pediatric patients out of 295 patients (12.8%) with LBL in CCHE from July 2007 to July 2020. The median follow-up period was 59.4 months. Males were 68.4% of the study patients, with a median age of 9.3 years.

All patients received acute lymphoblastic leukemia St. Jude total XV protocol initially, patient’s gender, pathological subtype, initial stage, central nervous system or bone marrow infiltration, and early response to induction treatment did not have an impact on relapse-free survival. Early relapse was documented in 89.47% of patients with 3y OS 5.8% and was 75% for late relapsed patients with a P-value of 0.01. Hematological or CNS relapse did not affect the outcome of the patients. Seventeen (44.7%) patients received FLAG-M as a salvage protocol with 3y OS 0%, and re-induction R16 was given to 17 (44.7%) patients with 3y OS 17.6%, with significant P-value. Sixteen (42%) patients had complete response post 2nd line therapy with 3y OS 31.2%, but 34.4% developed 2nd relapse, then 84.4% of patients died of active disease. Allogenic BMT was done for only 2 patients with a P-value of 0.1. In conclusion, early relapse and poor response to salvage chemotherapy worsen the outcome of relapsed pediatric LBL; giving re-induction R16 protocol, followed by allogeneic HSCT, improves the outcome.


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