***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Children and adolescents with Burkitt Lymphoma ( BL ) and combined central nervous system ( CNS ) and bone marrow involvement still have a poor prognosis with chemotherapy alone . We therefore investigated in children and adolescents with bone marrow ( ≥25 % blasts ) and /or CNS‐positive Burkitt lymphoma the chemoimmunotherapy combination of rituximab ( 375 mg/m2 ) and the st and ard chemotherapy arm of our previously reported French‐American‐British ( FAB ) Lymphome Malins de Burkitt ( LMB ) 96 trial . Central pathological and cytogenetic characterization was also performed . There were 40 evaluable patients with Burkitt histology ( 25 with leukaemia and 15 with CNS disease ± leukaemia ) . The chemoimmunotherapy regimen was well tolerated . The incidence of grade III/IV mucositis during induction cycles with combined chemotherapy and rituximab was 31 % and 26 % , respectively . The 3‐year event‐free survival (EFS)/overall survival ( OS ) was 90 % ( 95 % confidence interval [ CI ] , 76–96 % ) in the entire cohort and 93 % ( 95 % CI , 61–99 % ) in patients with CNS disease . Based on the results of this trial , an international r and omized study of FAB/LMB 96 chemotherapy ± rituximab for high‐risk patients is currently under investigation Purpose : The prognosis for children with recurrent CD20 + non – Hodgkin 's lymphoma is dismal . A radiolabeled anti-CD20 antibody , 90yttrium-ibritumomab-tiuxetan ( 90Y-IT ) , is Food and Drug Administration approved for adults with recurrent indolent CD20 + B cell – non – Hodgkin 's lymphoma . There is no data on the safety and feasibility of 90Y-IT in refractory childhood CD20 + lymphoma . Experimental Design : Children and adolescents with refractory/relapsed CD20 + lymphoma were eligible for this phase I radioimmunotherapy study . Patients ( n = 5 ) received rituximab ( 250 mg/m2 i.v . ) on days 0 and 7 and indium-111 ibritumomab-tiuxetan ( 5 mCi i.v . ) on day 0 . Dosimetry studies were done on days 0 , 1 , 3 , and 6 . Immediately after rituximab on day 7 , patients received 90Y-IT if dosimetry studies showed < 2000 cGy exposure to all solid organs and < 300 cGy to marrow , as well as 0.4 mCi/kg in patients with good marrow reserve ( n = 3 ) and 0.1 mCi/kg in patients with poor marrow reserve ( after bone marrow transplant ; n = 2 ) . Results : No patients experienced nonhematologic or hematologic dose-limiting toxicity . Human antimurine antibody/human antichimeric antibody incidence was 0 % . One patient experienced grade II infusion – related chills associated with rituximab . The following are the means of organ radiation exposure ( cGy ) : kidneys 341 ( 112 - 515 ) , liver 345 ( 83 - 798 ) , lungs 309 ( 155 - 519 ) , marrow 46 ( 20 - 78 ) , spleen 565 ( 161 - 816 ) , and total body 42 ( 14 - 68 ) . Conclusions : Based on these findings , an exp and ed investigator-initiated limited institutional phase II study has been design ed to further evaluate the safety , tolerability , and response rate with 90Y-IT dose stratification based on marrow reserve Lymphomas represent the third most common group of cancers in childhood and adolescence , mature B non Hodgkin 's lymphoma ( B-NHL ) accounting for up to 60 % of newly diagnosed patients . The diagnosis of specific entities of B-NHL is based on well-defined morphologic analysis , immunophenotyping , cytogenetics and molecular genetics , which determine the optimal treatment strategy . In adult population a major turning point in treatment of B-NHL has been achieved since rituximab , in combination with CHOP has improved the survival rate up to 19 % . Rituximab is a chimeric monoclonal antibody that targets CD20 , a transmembrane calcium channel expressed on normal and malignant B-cells that mediates cytotoxic , apoptotic and anti-proliferative effects . The effect of rituximab in pediatric population is still not well enough investigated . Based on morphology and immunophenotype of malignant cells , seven children with B-NHL in our institution were eligible for treatment with modified B-NHL-Berlin-Frankfurt-Münster (BFM)-95-based protocol with rituximab administered on day -5 . The complete remission was achieved in all seven patients . Six patients are still in complete remission at least 12 months after having finished chemotherapy and one patient relapsed two months after the last cycle and subsequently died . Major adverse effects observed during treatment were prolonged B-cell depletion and myelosuppression .  Rituximab in combination with B-NHL-BFM-95 protocol was otherwise well tolerated and proved to be effective in children and adolescents with B-NHL . The number of our patients is too small and the follow-up of a larger group of patients will help in defining the role of rituximab in the treatment of childhood B-NHL Pediatric mature B-cell non-Hodgkin lymphomas ( B-NHLs ) are highly aggressive malignant tumors that are curable with chemotherapy ( ChT ) . High-dose methotrexate ( MTX ) is considered indispensable for successful treatment , but this therapy frequently induces severe mucositis and infectious complications , especially in induction , which can cause treatment failure . A prospect i ve multicenter trial of combined immunochemotherapy for advanced-stage B-NHL with rituximab and the modified NHL-BFM-90 protocol was conducted . The major differences from the original protocol were a decrease in the dose of MTX from 5000 to 1000 mg/m2/24 h in the first 2 ChT blocks and the addition of rituximab at 375 mg/m2 to each of the first 4 blocks of ChT. Eighty-three newly diagnosed patients with a median age of 8.84 years with Burkitt lymphoma/leukemia and diffuse large B-cell lymphomas stage III to IV were included . Four patients died during induction ChT due to tumor lysis syndrome and infection . Two additional patients died subsequently due to tumor resistance . Complete remission was achieved in 77 ( 92.8 % ) patients ; 2 patients relapsed at 1 and 3 months , and 2 developed secondary malignancies at 1 and 6.5 years , respectively , after the completion of therapy . The overall survival probability was 82%±8 % with a median follow-up of 65.2 months . Combined therapy with rituximab and intensive ChT with a reduced MTX dose of 1 g/m2 in the 2 induction courses was feasible and produced high cure rates in patients with pediatric advanced-stage mature B-NHL BACKGROUND To estimate the response rate and therapy related toxicities of the anti-CD20 monoclonal antibody rituximab when combined with chemotherapy including ifosfamide , carboplatin , and etoposide ( ICE ) in patients with relapsed and refractory B-cell non-Hodgkin lymphoma and mature B-cell acute lymphoblastic leukemia ( B-ALL ) . METHODS Patients received rituximab and ICE for 1 - 3 cycles , depending upon response . Rituximab ( 375 mg/m(2 ) ) was given on day 1 and 3 of each cycle ( day 1 only for cycle 3 ) , with ifosfamide ( 3,000 mg/m(2 ) ) and etoposide ( 100 mg/m(2 ) ) given on days 3 , 4 , and 5 and carboplatin ( 635 mg/m(2 ) ) given on day 3 only . RESULTS Twenty-one patients were enrolled , of whom 20 were eligible and evaluable . Although hematologic toxicities were common , only one patient was removed from study due to prolonged myelosuppression . Toxicities related to infusions of rituximab were frequent but manageable . Of the six eligible patients with diffuse large B-cell lymphoma , three achieved complete remission ( CR ) , one had stable disease ( SD ) , and two had progressive disease ( PD ) . Of the 14 eligible patients with Burkitt lymphoma and B-ALL , there were four complete responses ( CR ) , five partial responses ( PR ) , one SD , and four with PD . Thus , the CR/PR rate for the entire group was 12/20 ( 60 % ) . Following completion of protocol therapy six patients were able to proceed to consolidation with high-dose therapy and stem cell rescue . CONCLUSIONS The combination of rituximab and ICE chemotherapy was associated with an encouraging objective response ( OR ) rate and an acceptable toxicity profile Optimal therapy for posttransplant lymphoproliferative disease ( PTLD ) remains problematic . A phase II trial adding rituximab to a low‐dose cyclophosphamide and prednisone regimen was conducted for pediatric patients with Epstein – Barr virus ( EBV ) ( + ) , CD20 ( + ) PTLD . Fifty‐five patients were enrolled . Toxicity was similar for cycles of therapy containing rituximab versus those without . The complete remission ( CR ) rate was 69 % ( 95 % confidence interval ( CI ) ; 57%–84 % ) . Of 12 patients with radiographic evidence of persistent disease at the end of therapy , eight were in CR 28 weeks later without further PTLD therapy . There were 10 deaths , 3 due to infections while receiving therapy and 7 from PTLD . The 2‐year event‐free survival ( alive with functioning original allograft and no PTLD ) was 71 % ( 95 % CI : 57%–82 % ) and overall survival was 83 % ( 95 % CI : 69%–91 % ) with median follow‐up of 4.8 years . Due to small numbers , we were unable to determine significance of tumor histology , stage of disease , allograft type or early response to treatment on outcome . These data suggest rituximab combined with low‐dose chemotherapy is safe and effective in treating pediatric with EBV ( + ) PTLD following solid‐organ transplantation PURPOSE The activity of rituximab in pediatric B-cell non-Hodgkin 's lymphoma ( B-NHL ) has not yet been determined . We conducted a phase II window study to examine activity and tolerability of rituximab in newly diagnosed pediatric B-NHL . PATIENTS AND METHODS Patients younger than age 19 years with CD20(+ ) B-NHL with at least one measurable site were eligible . Treatment consisted of rituximab at 375 mg/m(2 ) administered intravenously on day 1 ; concomitant therapy consisted of rasburicase , intrathecally ( IT ) triple drug ( methotrexate , cytarabine , and prednisolone ) on days 1 and 3 for CNS-positive patients and steroids only for anaphylaxis . Response criterion was the product of the two largest perpendicular diameters of one to three lesions and /or the percentage of blasts in bone marrow ( BM ) or peripheral blood ( PB ) within 24 hours before rituximab and on day 5 . Responders had > or = 25 % decrease of at least one lesion or BM or PB blasts and no disease progress at other sites . Response rate ( RR ) was set at 45 % for unfavorable activity or at 65 % for favorable activity . RESULTS From April 2004 to August 2008 , 136 patients were enrolled .  National Cancer Institute Common Toxicity Criteria 3/4 toxicities attributable to rituximab were general condition , 15 % ; fatigue , 13 % ; anaphylaxis , 7 % ; infection , 3 % ; glutamic-oxaloacetic transaminase/glutamic-pyruvic transaminase , 8 % ; no capillary leakage ; and no toxic death .  Forty-nine patients were not evaluable for response because of withdrawal from the study ( n = 16 ) , IT therapy in CNS-negative patients ( n = 8) , corticosteroid treatment ( n = 3 ) , technical inadequacy of response evaluation ( n = 21 ) , or no evaluable lesion ( n = 1 ) . Of 87 evaluable patients , 36 were responders ( RR , 41.4 % ; 95 % CI , 31 % to 52 % ) ; among them , 27 of 67 with Burkitt lymphoma and seven of 15 with diffuse large B-cell lymphoma . A response was more frequently observed in BM ( 12 of 18 ) compared with solid tumor lesions ( 36 of 108 ; P = .007 ) . CONCLUSION Rituximab is active as a single-agent in pediatric B-NHL even though the RR was lower than requested in the phase 
    Output:
    
Phase I and II studies show a positive effect of using antibody therapy in childhood lymphoma .