T-cell lymphoblastic lymphoma (T-LBL), a type of cancer of the blood, is the most common childhood lymphoma. The use of intensive chemotherapy drugs, usually with some radiation therapy to the affected area, results in survival with no recurrence (return) of disease in 60 to 70% of patients. To prevent recurrences in some children, high doses of radiation therapy to the chest, brain, and spine are used. Because radiation used in children can cause side effects, such as problems with a child’s growth and development and occurrence of second cancers, researchers have sought to develop treatments that do not require high-dose radiation. German researchers found that an intensive chemotherapy combination used with only moderate radiation therapy to the head may cure 90% of children with T-LBL.

Childhood T-cell lymphoblastic lymphoma is a type of non-Hodgkin’s lymphoma, or cancer of the blood, that can occur in children. It is characterized by the presence of cancerous cells in the lymph system, which includes the blood vessels, lymph nodes, and organs such as the spleen, thymus, and tonsils. T-LBL can start almost anywhere in the lymph system, and is usually associated with the emergence of cancer behind the sternum in the chest. Depending on patient age and stage (extent of disease at diagnosis) of cancer, T-LBL can be treated with radiation therapy, chemotherapy, and/or biologic therapies (immunotherapies that may help the body’s immune system to fight the cancer and infections). Bone marrow or blood stem cell transplantation is also being studied as a treatment option for persons with this type of cancer.

Researchers treated 105 children with T-LBL with an intensive 8-drug chemotherapy regimen over 9 weeks, followed by consolidation chemotherapy for 8 weeks, and then maintenance chemotherapy. Because relapses of lymphoma often occur in the brain, moderate doses of radiation therapy to the head were used preventatively. In addition, the chemotherapy drugs used included those that are able to penetrate the fluid surrounding the brain and spinal cord. After 5 years, 90% of the children treated for T-LBL were alive and without any recurrence of disease. Eight children had relapses, 1 developed a second cancer (acute myelogenous leukemia), and 1 died from treatment-related causes.

These researchers concluded that the intensive chemotherapy and use of preventative moderate-dose radiation therapy to the head cured approximately 90% of children with T-LBL, without requiring high doses of radiation to the chest, brain, and spine. ( Blood, Vol 95, No 8, pp 416-421, 2000)