Interferon-α after autologous stem cell transplantation in pediatric patients with advanced Hodgkin's lymphoma

Ifosfamide, gemcitabine, and vinorelbine is an effective salvage regimen with excellent stem cell mobilization in relapsed or refractory pediatric Hodgkin lymphoma

We describe 12 pediatric patients (8-16 years) with primary refractory (N = 6) or first relapse (N = 6) Hodgkin lymphoma (HL) treated with ifosfamide, gemcitabine, and vinorelbine (IGEV). The overall response rate to IGEV was 100%, with seven (58%) complete responses (CR) and five (42%) partial responses. Successful CD34⁺ stem cell mobilization was achieved in all patients. Following subsequent autologous stem cell transplantation, 10 patients (83%) achieved CR. At a median follow-up of 71 months, 11 patients had no evidence of disease. Five-year second event-free survival and overall survival were 83% ± 11.0% and 90.0% ± 9.5%, respectively. IGEV is an effective salvage regimen for children with relapsed/refractory HL.

Outcome of autologous hematopoietic stem cell transplantation in children and adolescents with relapsed or refractory Hodgkin's lymphoma

This study evaluates the outcome of 66 pediatric patients with rrHL who underwent autoHSCT. Twenty-nine patients experienced early relapse, and 19 patients experienced late relapse. Of 18 newly diagnosed with HL, 13 were primary refractory disease and five had late responsive disease. At the time of transplantation, only 68% of the patients were chemosensitive. The majority of patients received BCNU + etoposide + ara-C + melphalan for conditioning (45/66), and peripheral blood (56/66) was used as a source of stem cells. After a median follow-up period of 39 months, 46 patients were alive. At five yr, the probabilities of OS, EFS, the relapse rate, and the non-relapse mortality rate were 63.1%, 54.3%, 36.4%, and 9.1%, respectively. The probability of EFS in chemosensitive and chemoresistant patients at five yr was 72.3% and 19%, respectively (p < 0.001). Multivariate analysis showed that chemoresistant disease at the time of transplantation was the only factor predicting limited both OS (hazard ratio = 4.073) and EFS (hazard ratio = 4.599). AutoHSCT plays an important role for the treatment of rrHL in children and adolescents, and survival rates are better for patients with chemosensitive disease at the time of transplantation.

Haematopoietic SCT for children and adolescents with relapsed and refractory Hodgkin's lymphoma

Despite the generally excellent prognosis of children and adolescents with Hodgkin's lymphoma (HL), approximately 15% of patients relapse. Salvage therapy options include further chemo-radiotherapy and autologous or allogeneic haematopoietic SCT (HSCT). Autologous HSCT following high-dose chemotherapy, the standard treatment for adult patients with relapsed HL, is also effective in paediatric patients, but randomized trials showing its superiority to conventional therapy are lacking. Although patients with late relapse (>12 months after completion of therapy) may be cured with conventional therapy, those with progressive disease or early relapse (3-12 months) are considered candidates for autologous HSCT. According to patient selection criteria, overall and disease-free survival rates after autologous HSCT are 43-95% and 31-70%, respectively. Short time to relapse and refractory disease at the time of autologous HSCT remain the most important risk factors. Data on allogeneic HSCT in children with HL are scarce. Broader use has been hampered for a long time mainly by high non-relapse mortality, offsetting the advantage of a graft-vs-lymphoma effect. Data suggest that young patients with recurring disease following autologous HSCT, as well as some patients with multiple relapses and selected patients with refractory lymphoma, might benefit from allogeneic HSCT, but relapse remains the major challenge.