ISSN 1866-8836
Клеточная терапия и трансплантация

LY-04. Autologous hematopoietic stem cell transplantation in children with primary mediastinal large B-cell lymphoma

Andrey V. Kozlov, Ilya V. Kazantsev, Tatiana V. Iukhta, Polina S. Tolkunova, Asmik G. Gevorgian, Ilya Y. Nikolaev, Alexander N. Galimov, Olga I. Bogdanova, Daria A. Zvyagintseva, Margarita S. Golenkova, Olesia S. Yudintseva, Alexander N. Shvetsov, Vadim V. Baykov, Elena V. Babenko, Maria A. Estrina, Yuri A. Punanov, Elena V. Morozova, Alexander D. Kulagin, Natalia B. Mikhailova, Ludmila S. Zubarovskaya

RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia

Dr. Andrey V. Kozlov, e-mail:

doi 10.18620/ctt-1866-8836-2021-10-3-1-148


Autologous hematopoietic stem cell transplantation (auto-HSCT) is a standard approach for remission consolidation in patients with relapsed or refractory (R-R) non-Hodgkin lymphoma (NHL). Nowadays there are limited data on auto-HSCT in children with primary mediastinal large B-cell lymphoma (PMBCL) due to rarity of this subtype. The aim of the study was to assess the effectiveness of auto-HSCT in children with PMBCL.

Materials and methods

In RM Gorbacheva Research Institute, twelve children and adolescents with PMBCL received auto-HSCT (Table 1). According to modified Murphy classification, all the patients had stage III at the onset of the disease. Refractory NHL was diagnosed in the majority (n=9, 75%) and relapsed NHL in 3 patients (25%). Karnofsky performance status scale was ≥90% in all the patients. Median interval from diagnosis to auto-HSCT was 294 days (166-738). Median number of prior therapy lines was 2 (2-4). In the majority of the patients (n=11, 92%), a first-line treatment was carried out according to the principles developed by the BFM group, and one patient received a CHOP-based regimen. As a second-line treatment, nine patients (75%) received R-ICE (rituximab, ifosfamide, carboplatin, etoposide); the rest of the patients were treated with other regimens (CHOEP, IGEV and DHAP). Histological confirmation of R/R NHL (“second look”) was carried out in 2 (17%) patients. Remission prior to auto-HSCT was achieved in 100% of cases. The graft sources were peripheral hematopoietic stem cells (n=9, 8%) and bone marrow (n=3, 3%). The median of CD34+ cells/kg was 4.8×106 (2.6-7). We used BEAM (n=3, 25%) and BeEAM (n=9, 75%) as conditioning regimens. Both protocols consisted of etoposide 200 mg/m2/day from D5 to D2, cytarabine 400 mg/m2/day from D5 to D2, melphalan 140 mg/m2/day on D1. The regimens differed in the following: we used carmustine 300 mg/m2/day on D6 in BEAM, or bendamustine 160 mg/m2/day on D7 and D6 in BeEAM. Immunotherapy or targeted therapy prior to auto-HSCT was used in all patients. The following medications were administered: rituximab (n=12, 100%), brentuximab vedotin (n=3, 25%), nivolumab (n=3, 25%).


Transplant-related mortality was not registered. During the follow-up period, two patients (17%) died (one due to NHL progression 689 days after auto-HSCT and another due to complications of further therapy, at 1180 days post-transplant). At the median follow-up of 828 (178-3375) days, the 5-year event-free survival rate was 75% (95% CI: 41-91), as seen in Fig. 1. Cumulative incidence of relapse was 25% (95% CI: 9-60).


Figure 1. Event-free survival in children with R/R PMBCL after auto-HSCT


According to the results of the present study, one may assume that the children in remission of R/R PMBCL prior to auto-HSCT may have favorable prognosis. This is in concordance with previously published data on improved outcome in adult patients with R/R PMBCL compared to other types of aggressive mature B-cell NHL [1]. Nevertheless, these data should be interpreted critically, due to limited patient number and absence of “second look” histology in the majority of children with R-R NHL.


1. Avivi I, Boumendil A, Finel H, Nagler A, de Sousa AB, Santasusana JMR et al. Autologous stem cell transplantation for primary mediastinal B-cell lymphoma: long-term outcome and role of post-transplant radiotherapy. A report of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2018; 53(8):1001-1009.


Autologous hematopoietic stem cell transplantation, children, non-Hodgkin lymphoma.

Table 1. Characteristics of the studied patients with primary mediastinal large B-cell lymphoma


Volume 10, Number 3

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doi 10.18620/ctt-1866-8836-2021-10-3-1-148

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