Outcome of children and adolescents with recurrent/refractory classical Hodgkin lymphoma, a study from the Société Française de Lutte contre le Cancer des Enfants et des Adolescents (SFCE)

Abstract

Summary There is little data available regarding children and adolescents with Hodgkin lymphoma (HL) who relapse after combined‐modality treatment, even though they have a substantial chance of cure. The purpose of this national retrospective study was to evaluate the outcome of patients with recurrent/refractory HL and determine adverse prognostic factors. From 1990 to 2006, 70 patients (median age 13·9 years) with refractory (n = 31) or first relapse (n = 39) HL were identified. Median time from end of treatment to relapse was 6 months (3–56). Relapses occurred in irradiated areas in 43/70 patients. Salvage therapy consisted of chemotherapy and 50 patients received high‐dose chemotherapy with autologous stem cell transplantation. Radiotherapy was performed in 29 cases, tandem autologous transplantation in five and allograft in three. With a median follow‐up of 40 months (2–140), significant prognostic factors were time to progression/relapse and response to therapy before autograft. Event‐free survival and overall survival in patients with refractory disease, early relapse and late relapse were 35 ± 9%, 67 ± 11%, 76 ± 10% and 48 ± 11%, 89 ± 7% and 80 ± 10%, respectively. As progression <3 months was a major adverse prognostic factor, novel therapeutic approaches are needed for this group of patients. By contrast, patients have substantial chance of long term second remission in case of relapse >3 months.

Pediatric Hodgkin lymphoma- biomarkers, drugs, and clinical trials for translational science and medicine

“…However, low-risk patients with late relapse and limited stage may be retrieved with standard dose chemotherapy (SDCT) and RT. The most common prognostic factors are chemosensitivity to initial salvage therapy [110], primary progressive disease [111, 112], time to relapse [113], and extranodal disease [114]. As with adult patients, pediatric patients also show poor prognosis, associated with time from diagnosis to first relapse of <1 year [115].…”

“…Therefore, alternative treatment approaches, including allogeneic stem cell transplant (alloSCT) or novel biological and targeted therapies, should be considered for these patients. In recent years, patients were more often retrieved with mini-BEAM [BCNU (carmustine), etoposide, cytarabine, melphalan] (BEAM chemotherapy in lower doses) [116]; MINE (mitoguazone, ifosfamide, vinorelbine, and etoposide) [113], or alternating IEP-ABVD (ifosfamide, etoposide, prednisolone) [109]. Reinduction regimen, ICE (Ifosfamide, carboplatin, and etoposide) in RR pediatric and adult patients has shown a combined response rate of 88% [117].…”

Treatment of Relapsed and Refractory Hodgkin’s Lymphoma in Children

“…Однако у 10 % пациентов развиваются рецидивы за-болевания или опухоль оказывается резистентной к проводимой терапии [3][4][5]. Несмотря на развитие рецидивов или рефрактерности к первичной терапии, у детей возможно достижение повторной ремиссии или преодоление резистентности путем применения более интенсивной химиотерапии.…”

“…Metzger и соавт., 3-летняя БСВ у больных с плохим ответом на противорецидивное лечение соста-вила 18 %, а у больных с полным ответом -97 % [6]. В исследовании S. Gorde-Grosjean БРВ детей с полным и частичным (> 70 % сокращения объема опухоли) эффектом была 77 %, без ответа на лечение (< 70 % сокращения объема опухоли) -10 % (p < 0,00001) [5]. В настоящем исследовании 3-летняя БРВ больных с полным ответом на терапию составила 85 %, а с ча-стичным -45 % (p = 0,012).…”

Ifosfamide, gemcitabine, and vinorelbine is an effective salvage regimen with excellent stem cell mobilization in relapsed or refractory pediatric Hodgkin lymphoma

“…With current therapy >85% of children with Hodgkin lymphoma (HL) achieve durable remission with primary therapy alone . Of those who fail initial therapy, salvage approaches, consisting of a range of chemotherapy regimens followed by high‐dose chemotherapy and autologous stem cell transplantation (ASCT), have demonstrated a five‐year overall survival (OS) of 60% to 70% in pediatric patients …”