Autologous hematopoietic stem cell transplantation in children and teenagers with Hodgkin’s lymphoma
Standard therapy cures 70-90% of patients with Hodgkin’s lymphoma (HL). Autologous hematopoietic stem cell transplantation (auto-HSCT) is an effective treatment option in chemosensitive relapsed or refractory disease. Despite longterm experience the data on the role of auto-HSCT in children are limited.
Materials and methods
Between 1993-2017, sixty-six HL patients at the median age of 16 (4-18) received auto-HSCT. Nodular sclerosis was diagnosed in 59 patients (89%), mixed cellularity type, in 6 (9%), lymphocyte depletion form, in 1 (2%). Clinical stage IV was assessed in 29 patients (44%), stage III, in 18 (27%), stage II, in 17 (26%), stage I, in 2 cases (3%); В symptoms were documented in 43 cases (65%). Relapsing course of the disease was revealed in 45 children and teenagers (68%), and refractory disease was confirmed in 21cases (32%). First-line therapy was carried out according to GPOH-HD protocol in 37 patients (56%); BEACOPP was applied in 21 cases (32%); ABVD, in 8 cases (12%). Second-line therapy included IEP/ABVD in GPOH-HD group, and DHAP or ICE in BEACOPP or ABVD groups. Early HL relapses (<12 months) were diagnosed in 26 children and teenagers (58%), and late relapse was stated in 19 patients (42%). Median number of therapy lines prior to auto-HSCT was 2 (1 to 6). Complete remission at the moment of auto-HSCT was achieved in 25 patients (38%), partial remission, in 25 (38%), stabilization, in 6 (9%), and progression of the disease was observed in 10 (15%). The conditioning regimens included BEAM (n=24, 36%), BeEAM (n=22, 33%), CBV (n=13, 20%), others (n=7, 11%).
Long-term overall survival (OS) was 48%, and progression free survival was 41%. The OS values in cases of chemosensitive disease were 64%, and in chemoresistant disease, 33%, (p=0.005). BeEAM and BEAM conditioning regimens have shown comparable effectiveness (OS, 62% and 51%, respectively, p=0.6). Transplant-related mortality was 4.5%. Lethal complications were associated with infections in 2 patients and high-dose chemotherapy toxicity in 1 patient (lung fibrosis).
Auto-HSCT cures approximately half of children and teenagers with relapsed or refractory HL. Chemosensitivity of the disease is an essential factor for the success of auto-HSCT. BEAM and BeEAM conditioning regimens are equally effective in children.
Hodgkin’s lymphoma, pediatric, hematopoietic stem cell transplantation, autologous, survival rates.