Pediatric mature B-cell non-hodgkin lymphoma in India: A retrospective multicenter pooled analysis of treatment approaches and outcomes

Background

Published data on outcomes of pediatric mature B-cell non-Hodgkin lymphoma (B-NHL) from India is limited and difficult to interpret due to small sample size and non-uniform treatment protocols. This study aims to do a pooled analysis of published patient data from multiple centers across India to provide a clearer understanding of survival rates and treatment-related toxicities with respect to the treatment protocols in this population.

Methods

A pooled analysis was conducted of patient data from 505 children with mature B-NHL, including Burkitt lymphoma (n = 395), diffuse large B-cell lymphoma (DLBCL, n = 52), and other subtypes (n = 58), treated from 2000 to 2022 at seven major cancer centers in India. Outcomes assessed were grade 3/4 toxicities, toxic deaths, relapse/progression, and survival rates.

Results

Most patients (401/505) presented with advanced disease; bone marrow and CNS involvement were observed in 13.9 % and 6.9 % of cases, respectively. Treatment protocols primarily included LMB (n = 208), BFM (n = 191), and MCP (n = 61). Grade 3/4 toxicities were reported in 79.2 % of patients, with higher rates observed with LMB protocol (92.1 %) compared to BFM (70.8 %) and MCP (70.1 %) (p < 0.001). Toxic death rates were similar across protocols. Overall survival (OS) and event-free survival (EFS) at a median follow-up of 17 months were 69.4 ± 2.2 % and 64.9 ± 2.2 %, respectively, with no significant differences in relapse/progression rates or stage-specific OS between protocols (p = 0.28 and 0.51).

Conclusions

This pooled analysis shows that although treatment-related toxicities differ by protocol, overall survival outcomes were similar across the LMB, BFM, and MCP regimens, despite being much lower than those reported from high income countries. Uniform standardized protocols may further improve outcomes for pediatric B-NHL in India.