Outcome of autologous hematopoietic stem cell transplantation in children and adolescents with relapsed or refractory Hodgkin's lymphoma

Abstract

This study evaluates the outcome of 66 pediatric patients with rrHL who underwent autoHSCT. Twenty-nine patients experienced early relapse, and 19 patients experienced late relapse. Of 18 newly diagnosed with HL, 13 were primary refractory disease and five had late responsive disease. At the time of transplantation, only 68% of the patients were chemosensitive. The majority of patients received BCNU + etoposide + ara-C + melphalan for conditioning (45/66), and peripheral blood (56/66) was used as a source of stem cells. After a median follow-up period of 39 months, 46 patients were alive. At five yr, the probabilities of OS, EFS, the relapse rate, and the non-relapse mortality rate were 63.1%, 54.3%, 36.4%, and 9.1%, respectively. The probability of EFS in chemosensitive and chemoresistant patients at five yr was 72.3% and 19%, respectively (p < 0.001). Multivariate analysis showed that chemoresistant disease at the time of transplantation was the only factor predicting limited both OS (hazard ratio = 4.073) and EFS (hazard ratio = 4.599). AutoHSCT plays an important role for the treatment of rrHL in children and adolescents, and survival rates are better for patients with chemosensitive disease at the time of transplantation.

Long‐term outcomes among 2‐year survivors of autologous hematopoietic cell transplantation for Hodgkin and diffuse large b‐cell lymphoma

“…High‐dose chemotherapy followed by autologous hematopoietic cell transplantation (auto‐HCT) remains the standard treatment for medically fit patients with relapsed or refractory aggressive lymphomas . Reported survival rates 3 to 5 years after auto‐HCT for classic Hodgkin lymphoma (cHL) and diffuse large B‐cell lymphoma (DLBCL) range from 40% to 70% . Treatment failure is most commonly due to relapse or progression of the underlying disease, which primarily occurs within the first 2 years after auto‐HCT .…”

“…1,2 Reported survival rates 3 to 5 years after auto-HCT for classic Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL) range from 40% to 70%. [2][3][4][5][6][7][8] Treatment failure is most commonly due to relapse or progression of the underlying disease, which primarily occurs within the first 2 years after auto-HCT. 1 For those patients who survive the initial post-auto-HCT period, long-term outcomes are not well described.…”

Outcome predictors of autologous hematopoietic stem cell transplantation in children with relapsed and refractory Hodgkin lymphoma: Single‐center experience in a lower‐middle‐income country

“…The primary cause of transplant failure in this study appears to be relapse with a median time to relapse of 23.85 months post‐AHSCT and a relapse rate of approximately 20%. Others described a cumulative incidence of relapse to be 40% with most of their patients experienced late relapse > 12 months post‐AHSCT …”

“…No prospective, randomized pediatric trials comparing the effectiveness of AHSCT with that of standard chemotherapy in relapsed children with HL have been conducted. 16 Many investigators reported marked improvement of EFS compared to non-transplanted patients and reflecting on a better OS. 20,22 We describe in this study the outcome and prognostic factors of 43 patients with refractory/relapsed HL who underwent HDCT followed by AHSCT at a single cancer center.…”

“…Patients who did not achieve CR1 following first-line treatment but who did achieve CR1 following multiple treatments prior to AHSCT were considered to be late CR1 responders. [15][16][17][18] Partial response was defined as persistence of tumor by clinical or radiographic evaluation by 30 days after therapy without further worsening of the disease. 15,19 Primary or relapsed refractory disease if they had a response other than CR or PR following first-line treatment or subsequent treatments for newly diagnosed HL (PRF) or if they were treated using salvage treatment modalities following their first relapse (RRF).…”