Allogeneic hematopoietic stem cell transplantation in children and adolescents with recurrent and refractory Hodgkin lymphoma: an analysis of the European Group for Blood and Marrow Transplantation

Abstract

Ninety-one children and adolescents 18 years or younger after allogeneic hematopoietic stem cell transplantation (HSCT) for relapsed or refractory Hodgkin lymphoma (HL) were analyzed. Fifty-one patients received reduced intensity conditioning (RIC); 40 patients received myeloablative conditioning (MAC). Nonrelapse mortality (NRM) at 1 year was 21% (؎ 4%), with comparable results after RIC or MAC. Probabilities of relapse at 2 and 5 years were 36% (؎ 5%) and 44% (؎ 6%), respectively. RIC was associated with an increased relapse risk compared with MAC; most apparent beginning 9 months after HSCT (P ‫؍‬ .01). Progressionfree survival (PFS) was 40% (؎ 6%) and 30% (؎ 6%) and overall survival (OS) was 54% (؎ 6%) and 45% (؎ 6%) at 2 and 5 years, respectively. Disease status at HSCT was predictive of PFS in multivariate analysis (P < .001). Beyond 9 months, PFS after RIC was lower compared with MAC (P ‫؍‬ .02). Graft-versus-host disease did not affect relapse rate and PFS. In conclusion, children and adolescents with recurring HL show reasonable results with allogeneic HSCT. Especially patients allografted in recent years with good performance status and chemosensitive disease show highly encouraging results (PFS: 60% ؎ 27%, OS: 83% ؎ 15% at 3 years). Because relapse remains the major cause of treatment failure, additional efforts to improve disease control are

Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin's lymphoma. Results of the HDR-ALLO study - a prospective clinical trial by the Grupo Espanol de Linfomas/Trasplante de Medula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation

“…The best conditioning protocol is unknown, although information from registry analyses indicates that the intensity of the conditioning regimen matters. In children and adolescents, the use of myeloablative protocols was not associated with higher NRM but significantly reduced the relapse incidence as compared to RIC protocols 29 The use of low dose total body irradiation (2 Gy) seems to be associated with a higher incidence of relapse and a lower progression-free survival. 16,19 Accordingly, enforcing the debulking of the tumor by adding further drugs or otherwise strengthening the anti-tumor effect may help to reduce the relapse rates after allogeneic SCT.…”

“…These patients might benefit from more aggressive conditioning and/or changing the GVHD prophylaxis. 29 The progression-free survival rate was 48% (95%CI, 44-52) at 1 year and 24% (95%CI, 22-27) at 4 years for the allografted population. The figures are significantly better for patients allografted with chemosensitive disease and particularly for patients allografted in complete remission.…”

Solid Tümörlerde Hematopoetik Kök Hücre Nakli

“…Allojenik nakillerde de nakil sırasındaki hastalık durumunun sonucu belirleyen en önemli prognostik faktör olduğu gösterilmiştir. Yakın zamanda yapılan EBMT çalışmasında allojenik nakil sonrası 2 ve 5 yıllık genel sağkalım oranları %54 ve 45 olarak belirtilmiş ve düşük yoğunluklu hazırlama rejimi verilenlerde relaps oranlarının daha fazla ve progresyonsuz sağkalımın daha düşük olduğu bulunmuştur 7 .…”

Hematopoetic stem cell transplantation in children

“…However, it has been observed that event-free survival is better in lymphoblastic lymphoma subtype with allogeneic transplantation (4% vs. 40%). Although acceptable results are obtained with allogeneic transplantation in cases of relapse and in refractory patients in Hodgkin lymphoma, relapse is still the most important cause of treatment failure (33).…”