Treatment of Primary Lymphoma of Bone in Patients Under 18 with Incomplete Resection
Clinical Scenario
This protocol applies to mature aggressive B-cell lymphoma of bone in paediatric patients following incomplete surgical resection. It covers stage I or stage II disease, or stage III when serum LDH is less than twice the upper limit of normal.
Key patient criterion — age under 18: This protocol is specific to children and adolescents younger than 18 years at diagnosis, a defining eligibility criterion that shapes the entire treatment framework applied.
Treatment Approach (Partial Overview)
Systemic multi-agent chemotherapy is employed, organised around alternating cycle types that begin with a structured prephase. Two established paediatric treatment concepts are used, each incorporating intrathecal chemotherapy within the cycle sequence.
Full cycle structure, alternating regimen details, and response-adapted decision points are available in the complete protocol →
Response Milestones
Key treatment goals include the absence of blasts in the bone marrow prior to the third course, and the absence of blasts in the cerebrospinal fluid during the third course.
References
- R2 Incomplete Stage I, II; stage III and LDH < 2 × ULN
- BI Incomplete stage I, II and III with LDH < 2 UNL and good response to COP (> 20% reduction)
- <18 years old at diagnosis.
- R2: P - A4 - B4 - A4 - B4
- B-I: COP - COPADM - COPADM – CYM – CYM
- Non-response in the CNS is diagnosed in cases of persistence of CSF blasts during the third course.
- Bone marrow non-response is defined as persistent blasts prior to the third course.
View source ↗