Rituximab and Reduced‐intensity Chemotherapy in Children and Adolescents with Mature B‐cell Lymphoma: Interim Results for 231 Patients Enrolled in the Second Russian‐Belorussian Multicentre Study B‐NHL‐2010M

The value of adding rituximab to chemotherapy in children with aggressive B‐cell non‐Hodgkin lymphoma (B‐NHL) is still insufficiently studied. We enrolled 231 patients [mean age 9 years old (range 2–17); male:female ratio 3·4:1] with Burkitt (BL, 179 patients, 76·7%), diffuse large B‐cell (32 patients, 14%), primary mediastinal B‐cell (14 patients, 6%), and other (6 patients, 2·6%) B‐cell lymphomas in a prospective study of immuno‐chemotherapy. Stages were I–II in 32% and III–IV in 68% of the patients. Four doses of 375 mg/m2 rituximab were added to the Berlin‐Frankfurt‐Munster‐NHL‐90‐like chemotherapy, with methotrexate being reduced or omitted in the first 2 induction blocks. The complete remission rate was 100% in limited‐stage and 91·4% in advanced‐stage patients. Five advanced‐stage patients (2·2%) died in induction and 1 patient with stage 2 B‐NHL died in remission; 11 patients in the high‐risk group progressed on therapy (3 non‐BL are alive after salvage) and 5 relapsed. Sixteen patients (9·7%) with advanced stage disease proceeded to transplant. With a median follow‐up of 46 months, 98·5 ± 1% of patients with limited disease and 88·1 ± 2% (88·1% in Risk Group 3; 82·6% in Risk Group 4) in advanced stages are alive. This study confirmed that combined immunochemotherapy for B‐lymphomas is highly effective in children, despite reducing the intensity of the induction blocks.