Improved Outcomes after Autologous Bone Marrow Transplantation for Children with Relapsed or Refractory Hodgkin Lymphoma: Twenty Years Experience at a Single Institution

Abstract

The purpose of this study is to evaluate the survival of pediatric patients undergoing autologous bone marrow transplantation (auBMT) for relapsed or refractory Hodgkin lymphoma (rrHL) and to identify factors that might contribute to their outcome. We reviewed the records and clinical course of 89 consecutive rrHL patients ≤ 21 years old who underwent auBMT at Stanford Hospitals and Clinics and the Lucile Packard Children's Hospital, Stanford between 1989 and 2012. We investigated, by multiple analyses, patient, disease, and treatment characteristics associated with outcome. Endpoints were 5-year overall and event-free survival. Our findings include that cyclophosphamide, carmustine, and etoposide (CBV) as a conditioning regimen for auBMT is effective for most patients ≤ 21 years old with rrHL (5-year overall survival, 71%). Transplantation after the year 2001 was associated with significantly improved overall survival compared with our earlier experience (80% compared with 65%). Patients with multiply relapsed disease or with disease not responsive to initial therapy fared less well compared with those with response to initial therapy or after first relapse. Administration of post-auBMT consolidative radiotherapy (cRT) also appears to contribute to improved survival. We are able to conclude that high-dose chemotherapy with CBV followed by auBMT is effective for the treatment of rrHL in children and adolescents. Survival for patients who undergo auBMT for rrHL has improved significantly. This improvement may be because of patient selection and improvements in utilization of radiotherapy rather than improvements in chemotherapy. Further investigation is needed to describe the role of auBMT across the entire spectrum of patients with rrHL and to identify the most appropriate preparative regimen with or without cRT therapy in the treatment of rrHL in young patients.

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

“…Due to the poor outcome of AHSCT for patients with multiple relapses, we transplanted 37 patients after their 1st salvage therapy 25 Notably, there was no statistical survival significance in this study as regards OS and EFS, due to small number of relapsing cases, for patients who received cRT compared to no cRT after AHSCT (P = 0.3 and 0.188, respectively). Our data and multiple other studies support the improved survival with irradiation after transplant, 23 but it remains of great importance to have a randomized pediatric trial to determine the beneficial role of irradiation following AHSCT.…”

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.…”

Comparison of two apheresis systems for autologous stem cell collections in pediatric oncology patients

“…A utologous stem cell transplantation (ASCT) is an integral part of the treatment of various pediatric cancers including high-risk neuroblastoma, various brain tumors, retinoblastoma, bone and soft tissue sarcomas, and lymphomas. [1][2][3][4][5] The initial part of the ASCT process requires collection of stem cells, which can be challenging in the pediatric population, especially for low-weight patients such as babies and toddlers, who are more prone to hemodynamic influences of fluid shifts due to the circulating blood volumes and to the exposure to anticoagulants and who may have more difficulty with the prolonged duration of the collection procedure. [6][7][8] Our medical center performs approximately 50 ASCTs per year for pediatric patients.…”