Journal of Clinical Oncology, Vol 18, Issue 22
(November), 2000: 3845-3853
© 2000 American Society for Clinical Oncology
Large-Cell Lymphoma Arising in the Mediastinum in Children and Adolescents Is Associated With an Excellent Outcome: A Children’s Cancer Group Report
By Mark A. Lones,
Sherrie L. Perkins,
Richard Sposto,
Marshall E. Kadin,
Carl R. Kjeldsberg,
John F. Wilson,
Mitchell S. Cairo
From the Pathology Department, Children’s Hospital of Orange County/St. Joseph Hospital, Orange; Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles; and Operations Center, Children’s Cancer Group, Arcadia, CA; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT; Department of Pathology, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, MA; and Division of Pediatric Oncology, Babies and Children’s Hospital of New York, Columbia University, New York, NY.
Address reprint requests to Mark A. Lones, MD, Children’s Cancer Group, PO Box 60012, Arcadia, CA 91066-6012.
PURPOSE: Large-cell lymphoma (LCL) arising in the mediastinum (LCL-M) is a heterogeneous group of non-Hodgkin’s lymphoma (NHL) that includes B-cell lymphomas as well as T-cell lymphomas, including anaplastic LCL. LCL-M is well recognized in young adults but is less well characterized and infrequent in children and adolescents.
METHODS: A retrospective review of Children’s Cancer Group therapeutic studies for nonlymphoblastic lymphomas (CCG-551, CCG-503, CCG-552, and CCG-5911) identified 20 patients with LCL-M, representing 7.2% of all LCLs classified by central pathology review.
RESULTS: The patients ranged in age from 4 to 19 years (median, 12.5 years; mean, 12 years); 55% of the patients were male. Although a variety of chemotherapy regimens were used, response was excellent, with all 20 patients (100%) achieving a complete response. Four patients (20%) experienced relapse locally or in distant sites including brain and kidney. One patient died of sepsis during therapy. For the 20 patients with LCL-M, the product-limit estimated 5-year event-free survival (EFS) and 5-year overall survival (OS) rates are 75% ± 10% and 85% ± 8%, respectively. For disseminated LCLs (192 cases), the EFS and OS rates were 50% ± 4% and 63% ± 4%, respectively, which differ significantly from the those of the LCL-M cases (EFS, P = .025; OS, P = .034). The 5-year EFS and OS rates for patients with localized LCL (67 cases) were 92 ± 3% and 97 ± 2%, respectively.
CONCLUSION: LCL-M is a heterogeneous group of NHLs that makes up approximately 7.2% of LCL in children and adolescents. Response to therapy and OS in this young age group seems excellent and superior to that of disseminated LCLs but inferior to that of other localized LCL. Future studies of LCL-M will evaluate short intense chemotherapy administered without radiation therapy.
Presented in part at the Forty-First Annual Meeting of the American Society of Hematology, December 3-8, 1999, New Orleans, LA.
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