Haematopoietic stem cell transplantation for relapsed or refractory anaplastic large cell lymphoma: a study of children and adolescents in Japan

Abstract

SummaryTo evaluate haematopoietic stem cell transplantation (HSCT) in children and adolescents, we reviewed the records of 47 patients who were ≤18 years, had relapsed or refractory anaplastic large cell lymphoma, and received HSCT between 1990 and 2010. At HSCT, complete remission (CR) was less common in allogeneic HSCT recipients (n = 24) than in autologous HSCT recipients (n = 23) (P = 0Á01). The autologous and allogeneic HSCT groups differed in terms of 5-year event-free survival (EFS) (38% vs. 50%, P = 0Á63), cumulative incidence of progress or relapse (49% vs. 28%, P = 0Á25), and treatment-related mortality (12% vs. 25%, P = 0Á40). However, these differences were not significant. Patients with non-CR at autologous HSCT had a significantly lower EFS rate (14% vs. 48%, P = 0Á03). Conversely, although those with non-CR at allogeneic HSCT had a lower EFS rate, this was not significant (44% vs. 63%, P = 0Á26). Reduced-intensity conditioning regimens were used for three of the 16 allogeneic HSCTs received by patients with non-CR. These three patients achieved CR, surviving 32-65 months after HSCT. These results demonstrated that allogeneic HSCT might be a treatment option for patients who do not achieve CR through conventional chemotherapy.

Hematopoietic stem cell transplantation in relapsed ALK+ anaplastic large cell lymphoma in children and adolescents: a study on behalf of the SFCE and SFGM-TC

“…However, our results are consistent with those of other studies, based on smaller series of patients with refractory or relapsed ALCL ( Table 4) that reported EFS rates between 46 and 75%. [4][5][6][7][8][9]15 In the three largest series, relapse rates were relatively low ranging from 10 to 28%, whereas toxicity-related mortality accounted for a large proportion of the events. Owing to the small numbers of patients included in each of these reports, no prognostic factor was identified but the authors pointed out the efficiency of this treatment in heavily pre-treated patients and in patients who had previously experienced disease progression under first-line chemotherapy.…”

“…23,24 The efficacy of this procedure has been achieved in 1/3 case in the present series as well as in several cases in literature 4,25 and especially in the recently published series from Japan in which 3/4 patients treated with a RIC regimen survived with no further relapse. 9 Performing an allograft at the first relapse may alleviate the toxicity of the procedure. However, allo-SCT may not be necessary for long-term disease control in all patients because a large number of patients with recurrent ALCL remain sensitive to chemotherapy.…”

“…The feasibility and efficacy of allo-SCT with good engraftment, acceptable toxicity and event-free survival rate ranging from 45 to 75% has been demonstrated in small series and case reports published so far. [4][5][6][7][8][9] Several risk factors have previously been associated with an unfavorable outcome in retrospective series of patients with relapsed ALCL. Relapses occurring within 12 months of the initial diagnosis and especially relapses occurring during therapy have been associated with lower survival.…”

Paediatric non‐Hodgkin lymphoma ‐ perspectives in translational biology

“…Pro‐inflammatory cytokines can be detected in the serum of ALCL patients at diagnosis (Mellgren et al , ). The high efficacy of allogeneic blood stem cell transplantation against relapsed ALCL suggests that a graft‐versus ALCL effect may exist (Woessmann et al , ; Gross et al , ; Fukano et al , ; Strullu et al , ). During the 2000s, two groups described that patients with ALK‐positive ALCL mount an immune response against the oncogenic ALK protein.…”

CNS progression during vinblastine or targeted therapies for high‐risk relapsed ALK‐positive anaplastic large cell lymphoma: A case series

“…Remission rates below 50% are reached with intensive re‐induction chemotherapy . Survival has been described after consolidation with allogeneic blood stem cell transplantation (SCT) . Weekly vinblastine (VBL) or targeted therapies such as ALK inhibitors or brentuximab vedotin (BV) achieve remissions in ALCL relapses with less toxicity compared to intensive re‐inductions .…”