Originally published as JCO Early Release 10.1200/JCO.2008.20.1764 on September 8 2009

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Single-Drug Vinblastine As Salvage Treatment for Refractory or Relapsed Anaplastic Large-Cell Lymphoma: A Report From the French Society of Pediatric Oncology

From the Department of Pediatric Oncology, Biostatistics and Epidemiology Unit, Institut Gustave Roussy, Villejuif; University Paris de Sud, Department of Pediatric Oncology, Institut Curie; Department of Pediatric Hematology, Hôpital Armand Trousseau, Université Pierre et Marie Curie; Department of Pediatric Hematology, Hôpital Saint Louis, Paris; Department of Pediatric Hematology, Hôpital Hautepierre, Strasbourg; Pediatric Department, Hôtel Dieu, Clermont-Ferrand; Institut of Pediatric Onco-Hematology, Lyon; Department of Pediatric Hematology, Hôpital Jeanne de Flandre, Lille; and Department of Pathology, Hôpital Purpan, Toulouse, France.

Corresponding author: Laurence Brugières, Department of Pediatric Oncology, Institut Gustave Roussy, 94805 Villejuif, France; e-mail: brugiere{at}igr.fr.

Purpose To evaluate the efficacy of vinblastine for relapsed/refractory anaplastic large-cell lymphoma (ALCL).

Patients and Methods Data were reviewed on all 36 patients included prospectively in the French database for pediatric ALCL who were treated with vinblastine (6 mg/m²/wk) for resistant primary disease (one), a first relapse (15), or subsequent relapses (20). Fifteen patients had undergone hematopoietic stem-cell transplantation (HSCT) for a previous relapse.

Results Six patients were not evaluable for response, 25 (83%) of 30 evaluable patients achieved a complete remission (CR), and five experienced progressive disease. Among the 31 patients who achieved a CR with vinblastine or before its initiation, six patients were treated with HSCT and 25 with vinblastine alone (median duration, 14 months). Overall, nine of 25 patients treated with vinblastine alone have remained in CR (median, 7 years since the end of treatment), and 16 patients have relapsed. Vinblastine was still efficient for subsequent relapses. With a median follow-up of 9.2 years, 12 patients have died (four as a result of toxicity after HSCT and eight as a result of disease), and 24 patients are alive (15 following treatment with single-agent vinblastine for the last event). Five-year overall survival is 65% (95% CI, 48% to 79%), and 5-year event-free survival is 30% (95% CI, 17% to 47%).

Conclusion Vinblastine is highly efficient in relapsed ALCL and may produce durable remissions. The optimal treatment duration still has to be assessed. These results should be borne in mind when designing future phase II studies with the targeted therapies directed against anaplastic lymphoma kinase.

Supported by the Société Françase des Cancers de L'Enfant/French Society for Pediatric Oncology (SFCE/SFOP), the Association Cent pour Sang la Vie, and the Institut Gustave Roussy, France.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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