High-Dose Therapy and Autologous Hematopoietic Stem-Cell Transplantation for Recurrent or Refractory Pediatric Hodgkin's Disease: Results and Prognostic Indices

Abstract

More than half of children with relapsed or refractory HD can be successfully treated with the combination of high-dose therapy and AHSCT, confirming the efficacy of this approach. Further investigation is now required to determine the optimal timing of AHSCT, as well as to develop alternative regimens for those patients with factors prognostic for poor outcome after AHSCT.

Single-agent high-dose melphalan followed by auto-SCT for relapsed and refractory Hodgkin lymphoma in children and adolescents

“…Our group did mandate some evidence of chemosensitivity before receiving HDM and auto-SCT, in contrast to many other published reports, which may have biased our results towards better outcomes. 4,6,7,12,14,17 However, a review of our institutional registry from 1991 to 2009 revealed that no patient was ineligible for HDC because of the suboptimal response to salvage chemotherapy. The single patient in our series with stable disease pretransplant did have radiographic evidence of reduction in disease, but did not constitute a PR.…”

“…[2][3][4]6 More commonly used conditioning regimens in adults and children have achieved event-free survival rates between 40 and 60%. 2,[4][5][6]10,12,15 Although the NRM for those with HL treated with auto-SCT has decreased with time, the use of HDC with or without RT is not without toxicity. The NRM with CBV þ /ÀP has been reported between 23 and 26%, and when second malignancies are excluded, has been reported between 5 and 14%.…”

“…14 Our engraftment data were comparable with those previously published for auto-SCT in HL. 4,6,7,17 We consider the duration of follow-up of this cohort with HL to be adequate to comment on feasibility.…”

“…2,3 Most of the reported data describe an adult rather than a pediatric population, and the few reported pediatric series involve small numbers of patients. 2,[4][5][6] However, several studies suggest that the adult literature describing the use of auto-SCT in relapsed/refractory HL can be extrapolated to children and young adults. 1,6 Numerous HDC regimens have been used before autologous stem cell rescue.…”

“…1,6 Numerous HDC regimens have been used before autologous stem cell rescue. 2,[4][5][6][7][8][9][10][11][12] More commonly these regimens include CY, carmustine and etoposide, with or without cisplatin (CBV þ /ÀP) or BEAM. 7,10,13 The University of Calgary/Tom Baker Cancer Centre has used single-agent high-dose melphalan (HDM) as a local institutional protocol for over 20 years for adults with relapsed/refractory HL with comparable efficacy, reduced short-term morbidity and lower costs compared with more standard regimens.…”