Stem cell transplantation for pediatric lymphoma: past, present and future

Abstract

Lymphoma is the third most common cancer in children p15 years of age. The prognosis for children with newly diagnosed chemosensitive non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) has improved significantly. However, in children with relapsed and refractory NHL, the prognosis is not as promising and the best treatment approach for this poor risk group continues to be a challenge. Between 25 and 30% of patients with advanced stage HD still relapse and in subsets of this group, the outcome is dismal. Aggressive chemotherapy followed by autologous bone marrow transplantation has been used with some improvement in survival. Some centers have investigated allogeneic stem cell transplantation in pediatric patients with recurrent/relapsed lymphoma. There is little consistency in therapeutic approaches and there is no formal recommendation on the best approach for this poor prognostic subgroup. We illustrate the reported pediatric experience of transplantation for lymphoma and discuss how the results from these trials are influencing how we approach the treatment in certain subgroups of pediatric patients with relapsed/ refractory lymphoma.

Sequential myeloablative autologous stem cell transplantation and reduced intensity allogeneic hematopoietic cell transplantation is safe and feasible in children, adolescents and young adults with poor-risk refractory or recurrent Hodgkin and non-Hodgkin lymphoma

“…Few studies in children and adolescents have investigated the GvLy effect in patients with B and T-cell NHL 37 . Recently, the CIBMTR published a retrospective analysis of MAC AutoSCT and AlloHCT in children with NHL.…”

Advances in Hematopoietic Stem Cell Transplantation in Childhood and Adolescent Lymphomas

“…[2] Prognositc factors include chemoresponsiveness at relapse, disease status at relapse and performance status at relapse. [3] The most recent prospective trial performed by the Children’s Oncology Group analyzed children and adolescents with HL at relapse or progression and determined their EFS at the time of reinduction and through an autologous stem cell transplant following cyclophosphomide, BCNU and VP-16 conditioning.…”

“…[1] However, children and adolescents with relapsed/refractory HL following combined modality of chemotherapy and radiation therapy have a worse prognosis, often requiring reinduction therapy followed by some form of stem cell transplantation. [2]…”

Prolongation of cardiac allograft survival by syngeneic Hematopoietic stem/progenitor cell transplantation in mice

“…6 It is a complex treatment including immune ablation and immune reconstitution. 7 Studies in experimental animal models of autoimmune disease have firmly established the feasibility of autologous HSCT.…”