Clinical features and long-term outcome in children and adolescents with non-Hodgkin lymphoma: A report of the Taiwan Pediatric Oncology Group study TPOG-NHL-2010.

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Background: Children and adolescents with non-Hodgkin lymphoma (NHL) have different distributions of histologic subtypes and clinical characteristics compared to adult patients. In this study, we would like to report clinical features and treatment outcomes of children and adolescents with NHL by a national treatment protocol in Taiwan. Methods: We collected patients younger than 18 years of age diagnosed with NHL and registered to the Taiwan Pediatric Oncology Group (TPOG) between January 2008 and June 2023. All eligible patients were treated with the TPOG-NHL-2010 protocol, which was a BFM-based protocol without any targeted therapy and contained 5 regimens for major histology subtypes. The clinical features and treatment outcomes of patients with NHL were analyzed. Results: Four hundred and sixty-five children and adolescents with NHL were registered to the TPOG database. There were 303 boys and 162 girls. The median age at diagnosis was 11.8 years (range: 0.4 – 17.9 years). Advanced diseases accounted for 73.7% of patients at diagnosis (stage 3 in 215, stage 4 in 128). Burkitt/Burkitt-like lymphoma (23.7%) was the most prevalent histological subtypes, followed by diffuse large B cell lymphoma (23.0%), lymphoblastic lymphoma (22.8%), anaplastic large cell lymphoma (13.1%), and peripheral T cell lymphoma of (8.8%). Excluding 44 patients who had protocol violations or did not receive treatment with the TPOG protocol, 421 patients were eligible for further analysis. The median time of follow-up was 6.3 years. One patient had early loss to follow-up. Eleven patients had induction death, and 19 had induction failure. Among the remaining 390 patients who achieved remission, 47 had relapse, 4 developed 2 ^nd malignancy, and 2 had remission toxic death. Therefore, the 5-year overall survival and event-free survival were 86.5% and 80.5%, respectively. The 5-year event-free survival rates of for 4 major pediatric NHL subtypes were 87.6% for Burkitt/Burkitt-like lymphoma, 81.7% for diffuse large B cell lymphoma, 79.5% for lymphoblastic lymphoma, and 78.7% for anaplastic large cell lymphoma. Conclusions: The treatment outcome in children and adolescents with NHL in Taiwan was comparable with previous reports. Incorporation of more molecular analysis and potential targeted therapies could be considered for future trials.