How is relapsed pediatric non-Hodgkin lymphoma (NHL) treated?

Updated: Jun 14, 2018
  • Author: J Martin Johnston, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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As front-line therapies for pediatric non-Hodgkin lymphoma continue to evolve and improve, treatment of relapses is becoming increasingly problematic.

Reinduction regimens use novel chemotherapy combinations, such as ifosfamide, carboplatin, and etoposide (ICE). Depending on the presence of certain cell-surface markers, monoclonal antibodies (eg, the anti-CD20 antibody rituximab) may be added to the regimen. [82, 83]

In most cases, myeloablative chemotherapy with either autologous stem-cell rescue or allogeneic bone marrow transplantation may offer the best option for curative consolidative therapy.

Pembrolizumab is a monoclonal antibody that binds the programmed cell death-1 protein (PD-1) ligands PD-L1 and PL2. In June 2018, it was approved by the FDA for treatment of adult and pediatric patients with refractory primary mediastinal large B-cell lymphoma (PMBCL), or who have relapsed after 2 or more prior lines of therapy. Approval was based on data from the KEYNOTE-170 trial (n=53). The ORR was 45%, with a CRR of 11%, and a PRR of 34% percent. Median duration of response, based on 24 patients who responded, was not reached (range, 1.1+ to 19.2+ months). For the 24 responders, the median time to first objective response (complete or partial response) was 2.8 months (range, 2.1 to 8.5 months). [84]

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