Late health outcomes after contemporary lymphome Malin de Burkitt therapy for mature B-cell non-Hodgkin lymphoma: A report from the Childhood Cancer Survivor Study

Matthew J. Ehrhardt, Yan Chen, John T. Sandlund, Elizabeth C. Bluhm, Robert J. Hayashi, Kerri Becktell, Wendy M. Leisenring, Monika L. Metzger, Kirsten K. Ness, Kevin R. Krull, Kevin C. Oeffinger, Todd M. Gibson, Mitchell S. Cairo, Thomas G. Gross, Leslie L. Robison, Gregory T. Armstrong, Yutaka Yasui, Melissa M. Hudson, Daniel A. Mulrooney

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Abstract

PURPOSE The widely used, risk-based Lymphome Malin de Burkitt (LMB) chemotherapy regimen has improved survival rates for children with mature B-cell non-Hodgkin lymphoma (NHL); however, associated late effects remain understudied. We assessed late health outcomes after LMB treatment in the Childhood Cancer Survivor Study. PATIENTS AND METHODS Multivariable regression models compared chronic health conditions, health status, and socioeconomic and neurocognitive outcomes between survivors of NHL treated with the LMB regimen (n = 126), survivors of NHL treated with non-LMB regimens (n = 444), and siblings (n = 1,029). RESULTS LMB survivors were a median age of 10.2 years (range, 2.5 to 20.5 years) at diagnosis and 24.0 years (range, 10.3 to 35.3 years) at evaluation. Compared with siblings, LMB survivors were at increased risk for adverse health outcomes. However, survivors of NHL treated with LMB and non-LMB regimens did not differ with regard to risk of having any chronic health conditions, impaired health status, neurocognitive deficits, or poorer socioeconomic outcomes. Increased risk for the following specific neurologic conditions was observed in LMB survivors compared with non-LMB survivors: epilepsy (relative risk [RR], 15.2; 95% CI, 3.1 to 73.4); balance problems (RR, 8.9; 95% CI, 2.3 to 34.8); tremors (RR, 7.5; 95% CI, 1.9 to 29.9); weakness in legs (RR, 8.1; 95% CI, 2.5 to 26.4); severe headaches (RR, 3.2; 95% CI, 1.6 to 6.3); and prolonged arm, leg, or back pain (RR, 4.0; 95% CI, 2.2 to 7.1). The survivors from the group C LMB risk group (n = 50) were at the highest risk for these conditions; however, except for worse functional status (odds ratio, 2.7; 95% CI, 1.2 to 5.8), they were not at increased risk for other adverse health status or socioeconomic outcomes compared with non-LMB survivors. CONCLUSION Survivors treated with LMB and non-LMB regimens are largely comparable in late health outcomes except for excess neurotoxicity among LMB survivors. These data inform treatment efforts seeking to optimize disease control while minimizing toxicity.

Original languageEnglish
Pages (from-to)2556-2570
Number of pages15
JournalJournal of Clinical Oncology
Volume37
Issue number28
DOIs
StatePublished - Oct 1 2019

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    Ehrhardt, M. J., Chen, Y., Sandlund, J. T., Bluhm, E. C., Hayashi, R. J., Becktell, K., Leisenring, W. M., Metzger, M. L., Ness, K. K., Krull, K. R., Oeffinger, K. C., Gibson, T. M., Cairo, M. S., Gross, T. G., Robison, L. L., Armstrong, G. T., Yasui, Y., Hudson, M. M., & Mulrooney, D. A. (2019). Late health outcomes after contemporary lymphome Malin de Burkitt therapy for mature B-cell non-Hodgkin lymphoma: A report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology, 37(28), 2556-2570. https://doi.org/10.1200/JCO.19.00525