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Gardenswartz A, Cairo MS. Hematopoietic Progenitor Cell Transplantation in Children, Adolescents, and Young Adults With Relapsed Mature B-Cell NHL. J Natl Compr Canc Netw 2020; 18:1135-1142. [PMID: 32755988 DOI: 10.6004/jnccn.2020.7617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
Although children, adolescents, and young adults with newly diagnosed B-cell non-Hodgkin's lymphoma enjoy excellent overall survival with current chemoimmunotherapy, those with relapsed and/or refractory disease have a dismal prognosis. Although most clinicians would agree that hematopoietic progenitor cell transplantation after reinduction therapy is frontline therapy for these patients, there is no consensus as to what type of hematopoietic progenitor cell transplantation promises the best event-free and overall survival. This review outlines the disparate types of stem cell therapy that have been used in this difficult-to-treat population as well as the role of maintenance and CAR T-cell therapy in conjunction with stem cell therapy.
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Affiliation(s)
| | - Mitchell S Cairo
- Departments of Pediatrics.,Pathology.,Medicine.,Microbiology and Immunology, and.,Cell Biology and Anatomy, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, New York
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2
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Seetharaman R, Mahmood A, Kshatriya P, Patel D, Srivastava A. An Overview on Stem Cells in Tissue Regeneration. Curr Pharm Des 2020; 25:2086-2098. [PMID: 31298159 DOI: 10.2174/1381612825666190705211705] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deteriorations in tissues and decline in organ functions, due to chronic diseases or with advancing age or sometimes due to infections or injuries, can severely compromise the quality of life of an individual. Regenerative medicine, a field of medical research focuses on replacing non-functional or dead cells or repairing or regenerating tissues and organs to restore normal functions of an impaired organ. Approaches used in regenerative therapy for achieving the objective employ a number of means which include soluble biomolecules, stem cell transplants, tissue engineering, gene therapy and reprogramming of cells according to target tissue types. Stem cells transplant and tissue regeneration methods for treating various diseases have rapidly grown in usage over the past decades or so. There are different types of stem cells such as mesenchymal, hematopoietic, embryonic, mammary, intestinal, endothelial, neural, olfactory, neural crest, testicular and induced pluripotent stem cells. METHODS This review covers the recent advances in tissue regeneration and highlights the application of stem cell transplants in treating many life-threatening diseases or in improving quality of life. RESULTS Remarkable progress in stem cell research has established that the cell-based therapy could be an option for treating diseases which could not be cured by conventional medical means till recent. Stem cells play major roles in regenerative medicine with its exceptional characteristics of self-renewal capacity and potential to differentiate into almost all types of cells of a body. CONCLUSION Vast number of reports on preclinical and clinical application of stem cells revealed its vital role in disease management and many pharmacological industries around the globe working to achieve effective stem cell based products.
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Affiliation(s)
| | | | | | | | - Anand Srivastava
- Global Institute of Stem Cell Therapy and Research, 4660 La Jolla Village Drive, San Diego, CA 92122, United States
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3
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Abdalla A, Hammad M, Hafez H, Zaghloul MS, Taha H, El-Hennawy G, El-Wakeel M, Khaled M, Mohamed Y, El-Haddad A. 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. Pediatr Transplant 2019; 23:e13531. [PMID: 31271483 DOI: 10.1111/petr.13531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children and adolescents with HL have excellent long-term survival exceeding 95% after combined modality treatment. However, about 20% will either relapse or have PRF. Salvage HDCT followed by AHSCT is considered to be the preferential treatment. OBJECTIVE To describe the outcome (OS and EFS) and prognostic factors in pediatric patients with relapsed or refractory HL (r/rHL) who underwent AHSCT. METHODS We retrospectively included 43 pediatric patients with r/rHL who underwent AHSCT from July 1, 2007, till December 31, 2016, at the Children's Cancer Hospital of Egypt. MAC regimen given was CMV. RESULTS Of the whole cohort, 88.4% of patients achieved CR, while 11.6% had a positive PET scan prior to transplantation. The 3-year OS and EFS were 85% and 70.6%, respectively. The 3-year OS for patients > 10 years was 94% versus 65.5% for patients 10 years of age or younger (P = 0.046). There is strong tendency toward better 3-year OS for patients with negative PET scan as compared to those with positive PET scan before AHSCT, 89.4% vs 60%, respectively (P = 0.059). This tendency is also applicable when looking at the 3-year EFS for the two groups, 78.3% vs 40%, respectively (P = 0.069). CONCLUSION Poor predictors of OS were younger age and positive PET scan before AHSCT. The latter, along with single modality treatment before AHSCT, were poor predictors of EFS.
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Affiliation(s)
- Amr Abdalla
- Department of Pediatric Oncology and Stem Cell Transplantation Unit, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Department of Pediatric Oncology and Stem Cell Transplantation Unit, National Cancer Institute (NCI), Cairo University, Egypt
| | - Mahmoud Hammad
- Department of Pediatric Oncology and Stem Cell Transplantation Unit, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Department of Pediatric Oncology and Stem Cell Transplantation Unit, National Cancer Institute (NCI), Cairo University, Egypt
| | - Hanafy Hafez
- Department of Pediatric Oncology and Stem Cell Transplantation Unit, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Department of Pediatric Oncology and Stem Cell Transplantation Unit, National Cancer Institute (NCI), Cairo University, Egypt
| | - Mohamed Saad Zaghloul
- Department of Radiation Therapy, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Department of Radiation Therapy, National Cancer Institute (NCI), Cairo University, Egypt
| | - Hala Taha
- Department of Pathology, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Department of Pathology, National Cancer Institute (NCI), Cairo University, Giza, Egypt
| | - Gihan El-Hennawy
- Department of Nuclear Medicine, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Madeeha El-Wakeel
- Department of Radiodiagnosis, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Mohamed Khaled
- Department of Clinical Research, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Yasmin Mohamed
- Department of Clinical Research, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt
| | - Alaa El-Haddad
- Department of Pediatric Oncology and Stem Cell Transplantation Unit, Children Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.,Department of Pediatric Oncology and Stem Cell Transplantation Unit, National Cancer Institute (NCI), Cairo University, Egypt
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4
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Chu Y, Gardenswartz A, Termuhlen AM, Cairo MS. Advances in cellular and humoral immunotherapy - implications for the treatment of poor risk childhood, adolescent, and young adult B-cell non-Hodgkin lymphoma. Br J Haematol 2019; 185:1055-1070. [PMID: 30613939 PMCID: PMC6555680 DOI: 10.1111/bjh.15753] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with relapsed, refractory or advanced stage B non-Hodgkin lymphoma (NHL) continue to have a dismal prognosis. This review summarises current and novel cellular and immunotherapy for these high-risk populations, including haematopoietic stem cell transplant, bispecific antibodies, viral-derived cytotoxic T cells, chimeric antigen receptor (CAR) T cells, and natural killer (NK) cell therapy, as discussed at the 6th International Symposium on Childhood, Adolescent and Young Adult Non-Hodgkin Lymphoma on September 26th-29th 2018 in Rotterdam, the Netherlands, and explores the future of NK/CAR NK therapies.
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Affiliation(s)
- Yaya Chu
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | | | - Amanda M. Termuhlen
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Mitchell S. Cairo
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
- Department of Medicine, New York Medical College, Valhalla, NY, USA
- Department of Pathology, New York Medical College, Valhalla, NY, USA
- Department of Microbiology & Immunology, New York Medical College, Valhalla, NY, USA
- Department of Cell Biology & Anatomy, New York Medical College, Valhalla, NY, USA
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5
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Fujita N, Kobayashi R, Atsuta Y, Iwasaki F, Suzumiya J, Sasahara Y, Inoue M, Koh K, Hori T, Goto H, Ichinohe T, Hashii Y, Kato K, Suzuki R, Mitsui T. Hematopoietic stem cell transplantation in children and adolescents with relapsed or refractory B-cell non-Hodgkin lymphoma. Int J Hematol 2019; 109:483-490. [PMID: 30701466 DOI: 10.1007/s12185-019-02608-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/19/2019] [Accepted: 01/23/2019] [Indexed: 01/03/2023]
Abstract
We undertook a retrospective study using the national registry data of hematopoietic stem cell transplantation (HSCT) in Japan to investigate the effect of graft source, particularly autologous or allogeneic tissue, on the treatment outcome in patients aged less than 18 years with relapsed or refractory B-cell non-Hodgkin lymphoma (B-NHL). Survival analysis was conducted on 31 autologous HSCT (auto-HSCT) and 48 allogeneic HSCT (allo-HSCT) recipients between 1990 and 2013. The 5-year survival rates were significantly lower for allo-HSCT compared to auto-HSCT recipients (32% vs. 55%; P = 0.036). Multivariate analysis of survival rates identified allogeneic graft, Burkitt histology, and lack of response to chemotherapy as poor prognostic factors for survival. The cumulative incidence of treatment-related mortality (TRM) was significantly higher in allo-HSCT compared to auto-HSCT recipients (P = 0.017), explaining the difference in survival rates. In patients with Burkitt lymphoma (BL), overall survival was significantly inferior in the group of patients undergoing HSCT within 12 months from the initial diagnosis (P = 0.039). These data indicate that treatment outcomes for HSCT in children and adolescents with B-NHL were better in autograft recipients, suggesting that greater attention should be paid to the risk of TRM, especially after allografts, for patients with BL.
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Affiliation(s)
- Naoto Fujita
- Department of Pediatrics, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-Machi, Naka-ku, Hiroshima, 730-8619, Japan.
| | - Ryoji Kobayashi
- Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fuminori Iwasaki
- Department of Hematology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Junji Suzumiya
- Department of Oncology/Hematology, Shimane University Hospital, Izumo, Japan
| | - Yoji Sasahara
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroaki Goto
- Division of Hemato-Oncology/Regenerative Medicine, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Hashii
- Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Kato
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Ritsuro Suzuki
- Department of Oncology and Hematology, Shimane University Hospital Cancer Center, Izumo, Japan
| | - Tetsuo Mitsui
- Department of Pediatrics, Yamagata University School of Medicine, Yamagata, Japan
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6
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Cairo M, Auperin A, Perkins SL, Pinkerton R, Harrison L, Goldman S, Patte C. Overall survival of children and adolescents with mature B cell non-Hodgkin lymphoma who had refractory or relapsed disease during or after treatment with FAB/LMB 96: A report from the FAB/LMB 96 study group. Br J Haematol 2018; 182:859-869. [PMID: 29984828 DOI: 10.1111/bjh.15491] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/25/2018] [Indexed: 02/04/2023]
Abstract
We determined the risk factors associated with poor survival in children and adolescents with de novo mature B cell non-Hodgkin lymphoma (B-NHL) who had refractory or relapsed disease during or after the French-American-British mature lymphoma B (FAB/LMB) 96 multi-agent chemotherapy. Among the 1 111 registered on study, 104 patients (9·4%) had refractory disease or disease relapse after first complete remission. Among these 104 patients, 28 (27%) patients had refractory disease and 76 (73%) had relapsed disease. The estimated 1- and 2-year overall survival (OS) (95% confidence interval) was 31·5% (23·3-41·0%) and 22·3% (15·3-31·4%), respectively. Prognostic analysis of OS using a Cox multivariate model showed that factors independently associated with OS included lactate dehydrogenase ≥2 upper normal limit [hazard ratio (HR) = 2·86 (1·57-5·2), P = 0·0006]; time to failure (>6 months) [HR = 0·59 (0·36-0·97), P = 0·038]; and failure in bone marrow [HR = 2·78 (1·65-4·68), P = 0·0001]. New therapeutic strategies are required to significantly reduce refractory disease and disease relapse in patients with newly diagnosed mature B-NHL and, more importantly, there is a critical need to develop novel retrieval approaches in patients with chemotherapy-resistant disease.
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Affiliation(s)
- Mitchell Cairo
- Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA
| | | | | | | | - Lauren Harrison
- Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA
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7
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Lee S, Shah T, Yin C, Hochberg J, Ayello J, Morris E, van de Ven C, Cairo MS. Ruxolitinib significantly enhances in vitro apoptosis in Hodgkin lymphoma and primary mediastinal B-cell lymphoma and survival in a lymphoma xenograft murine model. Oncotarget 2018; 9:9776-9788. [PMID: 29515770 PMCID: PMC5839401 DOI: 10.18632/oncotarget.24267] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/09/2018] [Indexed: 12/13/2022] Open
Abstract
Hodgkin lymphoma (HL) and primary mediastinal B-cell lymphoma (PMBL) share similar molecular features by gene expression profiling. Frequent gains of chromosome 9p exhibit higher Janus Kinase 2 (JAK2) transcript levels with increased JAK2 activity, suggesting aberrant activity of JAK2 and STAT pathways. This signaling pathway alteration may in part play an important role in the pathogenesis and/or chemoradiotherapy resistance in HL and PMBL. Ruxolitinib is a potent and selective JAK1/JAK2 inhibitor, with activity against myeloproliferative neoplasms (MPNs) including those harboring the JAK2V617F mutation. We investigated the in vitro and in vivo efficacy of ruxolitinib and changes in downstream signaling pathways in HL and PMBL. We demonstrated that ruxolitinib significantly inhibited STAT signaling in both HL and PMBL with constitutively active JAK2 signaling. We also observed that ruxolitinib significantly induced in vitro anti-proliferative effects (p < 0.05) and increased programmed cell death (p < 0.05) against both HL and PMBL cells. Importantly, ruxolitinib significantly inhibited tumor progression by bioluminescence (p < 0.05) and significantly improved survival in HL (p = 0.0001) and PMBL (p < 0.0001) xenograft NSG mice. Taken altogether, these studies suggest that ruxolitinib may be a potential adjuvant targeted agent in the therapeutic approach in patients with high risk HL and PMBL.
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Affiliation(s)
- Sanghoon Lee
- Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY 10595, USA
| | - Tishi Shah
- Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA
| | - Changhong Yin
- Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA
| | - Jessica Hochberg
- Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA
| | - Janet Ayello
- Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA
| | - Erin Morris
- Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA
| | | | - Mitchell S. Cairo
- Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY 10595, USA
- Department of Medicine, Pathology, Microbiology and Immunology New York Medical College, Valhalla, NY 10595, USA
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8
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9
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Giulino-Roth L, O'Donohue T, Chen Z, Trippett TM, Klein E, Kernan NA, Kobos R, Prockop SE, Scaradavou A, Shukla N, Steinherz PG, Moskowitz AJ, Moskowitz CH, Boulad F. Outcome of children and adolescents with relapsed Hodgkin lymphoma treated with high-dose therapy and autologous stem cell transplantation: the Memorial Sloan Kettering Cancer Center experience. Leuk Lymphoma 2017; 59:1861-1870. [PMID: 29183202 DOI: 10.1080/10428194.2017.1403601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To evaluate outcomes and prognostic markers among children with relapsed Hodgkin lymphoma (HL) treated with autologous stem cell transplant (ASCT), we conducted a retrospective analysis of 36 consecutive pediatric patients treated at Memorial Sloan Kettering Cancer Center from 1989 to 2013. With a median follow-up of 9.6 years, the 10-year overall survival (OS) and event-free survival (EFS) were 74.1 and 67.1% respectively. Absence of B-symptoms, chemotherapy-sensitive disease, and transplant date after 1997 were each associated with superior EFS [HR 0.12 (p = .0015), 0.18 (p = .0039), and 0.17 (p = .0208), respectively]. Childhood Hodgkin International Prognostic Score at relapse (R-CHIPS) was calculated in a subset of patients (n = 22) and a lower score was associated with improved OS (HR 0.29, p = .0352) and a trend toward improved EFS (HR 0.38, p = .0527). In summary, ASCT results in durable remission for the majority of pediatric patients with relapsed HL. R-CHIPS should be evaluated in larger cohorts as a potential predictive tool.
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Affiliation(s)
- Lisa Giulino-Roth
- a Department of Pediatrics , Weill Cornell Medical College , New York , NY , USA.,b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Tara O'Donohue
- a Department of Pediatrics , Weill Cornell Medical College , New York , NY , USA.,b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Zhengming Chen
- c Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research , Weill Cornell Medical College , New York , NY , USA
| | - Tanya M Trippett
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Elizabeth Klein
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Nancy A Kernan
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Rachel Kobos
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Susan E Prockop
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Andromachi Scaradavou
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Neerav Shukla
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Peter G Steinherz
- b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Alison J Moskowitz
- d Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Craig H Moskowitz
- d Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Farid Boulad
- a Department of Pediatrics , Weill Cornell Medical College , New York , NY , USA.,b Department of Pediatrics , Memorial Sloan Kettering Cancer Center , New York , NY , USA
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10
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Hazar V, Kesik V, Aksoylar S, Karakukcu M, Ozturk G, Kupesiz A, Atas E, Oniz H, Kansoy S, Unal E, Tanyeli A, Erbey F, Elli M, Tacyildiz N, Karasu GT, Kocak U, Anak S, Yilmaz Bengoa S, Sezgin G, Atay D, Unal E, Uygun V, Kurucu N, Kaya Z, Yesilipek A. Outcome of autologous hematopoietic stem cell transplantation in children and adolescents with relapsed or refractory Hodgkin's lymphoma. Pediatr Transplant 2015; 19:745-52. [PMID: 26346042 DOI: 10.1111/petr.12573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Volkan Hazar
- Pediatric BMT Units, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Vural Kesik
- Pediatric BMT Units, Gulhane Military Medical Academy, Ankara, Turkey
| | - Serap Aksoylar
- Pediatric BMT Units, Ege University Faculty of Medicine, Izmir, Turkey
| | - Musa Karakukcu
- Pediatric BMT Units, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Gulyuz Ozturk
- Pediatric BMT Units, Medical Park Bahcelievler Hospital, İstanbul, Turkey
| | - Alphan Kupesiz
- Pediatric BMT Units, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Erman Atas
- Pediatric BMT Units, Gulhane Military Medical Academy, Ankara, Turkey
| | - Haldun Oniz
- Pediatric BMT Units, Tepecik Hospital, İzmir, Turkey
| | - Savas Kansoy
- Pediatric BMT Units, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ekrem Unal
- Pediatric BMT Units, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Atila Tanyeli
- Pediatric BMT Units, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Fatih Erbey
- Pediatric BMT Units, Medical Park Bahcelievler Hospital, İstanbul, Turkey
| | - Murat Elli
- Pediatric BMT Units, On Dokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Nurdan Tacyildiz
- Pediatric BMT Units, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gulsun Tezcan Karasu
- Pediatric BMT Units, Bahcesehir University Faculty of Medicine Medical Park Goztepe Hospital, Istanbul, Turkey
| | - Ulker Kocak
- Pediatric BMT Units, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Sema Anak
- Pediatric BMT Units, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Sebnem Yilmaz Bengoa
- Pediatric BMT Units, Bahcesehir University Faculty of Medicine, Medical Park Antalya Hospital, Antalya, Turkey
| | - Gulay Sezgin
- Pediatric BMT Units, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Didem Atay
- Pediatric BMT Units, Medical Park Bahcelievler Hospital, İstanbul, Turkey
| | - Emel Unal
- Pediatric BMT Units, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Vedat Uygun
- Pediatric BMT Units, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Nilgun Kurucu
- Pediatric BMT Units, Ankara Oncology Hospital, Ankara, Turkey
| | - Zuhre Kaya
- Pediatric BMT Units, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Akif Yesilipek
- Pediatric BMT Units, Bahcesehir University Faculty of Medicine Medical Park Goztepe Hospital, Istanbul, Turkey
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11
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Sumaili H, Al-Kofide A, Al-Seraihi A, Ayas M, Siddiqui K, El-Solh H, Al-Jefri A, Al-Ahmari A, Mohamed A, Anas M, Belgaumi AF. Outcome of pediatric patients with lymphoma following stem cell transplant: a single institution report. Leuk Lymphoma 2014; 56:1327-34. [PMID: 25139691 DOI: 10.3109/10428194.2014.951846] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hematopoietic stem cell transplant (HSCT) is recommended for pediatric patients with relapsed/refractory lymphoma even though the evidence for this is limited. We retrospectively reviewed records of 57 patients (29 Hodgkin lymphoma [HL], 28 non-Hodgkin lymphoma [NHL]) who underwent HSCT between 1995 and 2012. All demonstrated chemoresponsiveness prior to HSCT and 44 patients had a complete response. All underwent myeloablative conditioning, 38 chemotherapy-based and 19 total body irradiation-based. Forty-one patients received autologous and 16 allogeneic HSCT. Twelve (21%) died within 100 days post-HSCT, and 25 patients relapsed at a median of 1.6 months post-HSCT. Three patients developed second malignant neoplasms. Five-year overall survival (OS) was 50.5% and event-free survival (EFS) was 43.4%. Outcomes for HL were significantly better than those for NHL (OS 61.9% vs. 38.7% [p = 0.005] and EFS 60.4% vs. 26% [p = 0.008]). In summary, approximately half of all pediatric patients with lymphoma who failed first-line therapy and demonstrated chemosensitivity to second-line therapy can be salvaged with HSCT.
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Affiliation(s)
- Hassan Sumaili
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center , Riyadh , Saudi Arabia
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12
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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. Leukemia 2014; 29:448-55. [PMID: 24938649 DOI: 10.1038/leu.2014.194] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/23/2014] [Accepted: 06/02/2014] [Indexed: 12/28/2022]
Abstract
The outcome of children, adolescents and young adults (CAYA) with poor-risk recurrent/refractory lymphoma is dismal (⩽30%). To overcome this poor prognosis, we designed an approach to maximize an allogeneic graft vs lymphoma effect in the setting of low disease burden. We conducted a multi-center prospective study of myeloablative conditioning (MAC) and autologous stem cell transplantation (AutoSCT), followed by a reduced intensity conditioning (RIC) and allogeneic hematopoietic cell transplantation (AlloHCT) in CAYA, with poor-risk refractory or recurrent lymphoma. Conditioning for MAC AutoSCT consisted of carmustine/etoposide/cyclophosphamide, RIC consisted of busulfan/fludarabine. Thirty patients, 16 Hodgkin lymphoma (HL) and 14 non-Hodgkin lymphoma (NHL), with a median age of 16 years and median follow-up of 5years, were enrolled. Twenty-three patients completed both MAC AutoSCT and RIC AlloHCT. Allogeneic donor sources included unrelated cord blood (n=9), unrelated donor (n=8) and matched siblings (n=6). The incidence of transplant-related mortality following RIC AlloHCT was only 12%. In patients with HL and NHL, 10 year EFS was 59.8% and 70% (P=0.613), respectively. In summary, this approach is safe, and long-term EFS with this approach is encouraging considering the poor-risk patient characteristics and the use of unrelated donors for RIC AlloHCT in the majority of cases.
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13
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Abikoff CM, Cairo MS. Reduced intensity conditioning and hematopoietic stem cell transplantation in pediatric nonmalignant disease: a new therapeutic paradigm. J Pediatr 2014; 164:952-953.e2. [PMID: 24742647 DOI: 10.1016/j.jpeds.2014.01.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Cori M Abikoff
- Department of Pediatrics, New York Medical College, Valhalla, NY
| | - Mitchell S Cairo
- Department of Pediatrics, New York Medical College, Valhalla, NY; Department of Medicine, New York Medical College, Valhalla, NY; Department of Pathology, New York Medical College, Valhalla, NY; Department of Microbiology & Immunology, New York Medical College, Valhalla, NY; Department of Cell Biology & Anatomy, New York Medical College, Valhalla, NY.
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14
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Cairo MS, Woessmann W, Pagel J. Advances in hematopoietic stem cell transplantation in childhood and adolescent lymphomas. Biol Blood Marrow Transplant 2012; 19:S38-43. [PMID: 23073268 DOI: 10.1016/j.bbmt.2012.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mitchell S Cairo
- Departments of Pediatrics, New York Medical College, Valhalla, New York 10595, USA.
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15
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Kasow KA, Stewart CF, Barfield RC, Wright NL, Li C, Srivastava DK, Leung W, Horwitz EM, Bowman LC, Handgretinger R, Hale GA. A phase I/II study of CY and topotecan in patients with high-risk malignancies undergoing autologous hematopoietic cell transplantation: the St Jude long-term follow-up. Bone Marrow Transplant 2012; 47:1448-54. [PMID: 22426752 DOI: 10.1038/bmt.2012.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Fifty-eight consecutive children with high-risk malignancies were treated with CY, and targeted topotecan followed by autologous hematopoietic cell transplantation (AHCT) in a phase I/II Institutional Review Board-approved study. Twelve participants enrolled in phase I; 5 received dose level 1 of topotecan 3 mg/m(2) per day, with subsequent doses targeted to total systemic exposure of 100±20 ng h/mL and CY 750 mg/m(2) per day. Seven participants received dose level 2. CY dose escalation to 1 g/m(2) per day was considered excessively toxic; one died from irreversible veno-occlusive disease and two experienced reversible hepatotoxicity. These adverse events halted further dose escalation. A total of 46 participants were enrolled in phase II; results are on the 51 participants who received therapy at dose level 1, the maximum tolerated dose. Diagnoses included neuroblastoma (26), sarcoma (9), lymphoma (8), brain tumors (5), Wilms (2) and retinoblastoma (1). Twenty participants (39.3%) were in CR1 at enrollment; median age was 5.1 years. Most common non-hematological grade III-IV toxicity was gastrointestinal (n=37). Neutrophil and platelet engraftment occurred at a median of 15 and 24 days, respectively. Twenty-six (51%) participants remain alive at a median of 6.4 years after AHCT. CY 3.75 g/m(2), and targeted topotecan followed by AHCT are feasible and produce acceptable toxicity in children with high-risk malignancies.
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Affiliation(s)
- K A Kasow
- Division of Pediatric Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7236, USA.
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16
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Abstract
Leukemia and lymphoma are the most common and third most common pediatric malignancies, respectively, and share cell lineages, but the clinical and imaging manifestations of these malignancies vary substantially. Along with providing pertinent details on classification, epidemiology, and treatment, this article reviews the current roles of imaging in the management of childhood leukemia and lymphoma, with attention to diagnosis, staging, risk stratification, therapy response assessment, and surveillance for disease relapse and adverse effects of therapy. Advances in functional imaging are also discussed to provide insights into future applications of imaging in the management of pediatric patients with leukemia and lymphoma.
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Affiliation(s)
- R Paul Guillerman
- Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX 77030, USA.
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17
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Pillon M, Aricò M, Basso G, Locatelli F, Citterio M, Micalizzi C, Testi AM, Barisone E, Nardi M, Lombardi A, Rondelli R, Rosolen A. Long-term results of AIEOP-8805 protocol for acute B-cell lymphoblastic leukemia of childhood. Pediatr Blood Cancer 2011; 56:544-50. [PMID: 21298738 DOI: 10.1002/pbc.22787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 07/16/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute B-cell leukemia (B-ALL) is a rare form of pediatric leukemia characterized by a very high-proliferation index, rapid clinical progression, and a high frequency of central nervous system (CNS) involvement. Commonly, it is treated in the clinical trials for Burkitt lymphoma, of which it represents the leukemic counterpart. PROCEDURE Children with B-ALL diagnosed between 1988 and 1999 were enrolled in the AIEOP-8805 protocol. Treatment included six high-dose chemotherapy courses. No prophylactic CNS irradiation was administered. RESULTS Sixty-five consecutive patients were enrolled in the study. L3 morphology was observed in 57 of 65 patients (88%). Twenty-five children (38%) had tumor mass in addition to massive bone marrow infiltration; 11 children (17%) had CNS disease at diagnosis. Sixty-two patients obtained complete morphological remission of which 13 suffered a relapse, including 3 with initial CNS involvement. Ten-year overall survival and event-free survival were 77% and 75%, respectively. Neither relevant long-term toxicity nor second malignancies were observed. CONCLUSIONS The AIEOP-8805 confirmed that short high-dose chemotherapy is highly effective for the treatment of B-ALL without significant long-term adverse sequelae. Therapy modifications to reduce relapse rate, such as the use of anti-CD20 monoclonal antibody and more effective CNS treatment, are being tested.
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Affiliation(s)
- Marta Pillon
- Pediatric Onco-Hematology Unit, University Hospital of Padova, Padova, Italy
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18
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Shafer JA, Heslop HE, Brenner MK, Carrum G, Wu MF, Liu H, Ahmed N, Gottschalk S, Kamble R, Leung KS, Myers GD, Bollard CM, Krance RA. Outcome of hematopoietic stem cell transplant as salvage therapy for Hodgkin's lymphoma in adolescents and young adults at a single institution. Leuk Lymphoma 2010; 51:664-70. [PMID: 20367182 DOI: 10.3109/10428190903580410] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
For patients with relapsed Hodgkin's lymphoma (HL), high dose chemotherapy with stem cell rescue (HDCT-SCT) may improve survival over chemotherapy alone. We assessed the outcomes of HDCT-SCT in 37 consecutive adolescent and young adult patients with relapsed HL whose malignancy was categorized based on sensitivity to chemotherapy. We determined whether current outcomes supported the use of HDCT-SCT in all of our patients or just those patients with lower-risk characteristics such as chemosensitivity. With a median follow-up of 6.5 years, the 2-year overall survival (OS) was 89% (95% CI: 62-97%) for the chemosensitive patients (n = 21), whereas for patients with resistant disease (n = 16), OS was 53% (95% CI: 25-74%). Both autologous and allogeneic transplants were well tolerated, with 100-day treatment-related mortality under 10%. Our data show encouraging outcomes for patients with chemosensitive relapsed HL who receive hematopoietic stem cell transplant (HSCT) and support the value of the procedure even when the disease is chemoresistant.
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Affiliation(s)
- J A Shafer
- Center for Cell and Gene Therapy, Houston, TX 77030, USA
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19
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Harris RE, Termuhlen AM, Smith LM, Lynch J, Henry MM, Perkins SL, Gross TG, Warkentin P, Vlachos A, Harrison L, Cairo MS. Autologous peripheral blood stem cell transplantation in children with refractory or relapsed lymphoma: results of Children's Oncology Group study A5962. Biol Blood Marrow Transplant 2010; 17:249-58. [PMID: 20637881 DOI: 10.1016/j.bbmt.2010.07.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
Abstract
This prospective study was designed to determine the safety and efficacy of cyclophosphamide, BCNU, and etoposide (CBV) conditioning and autologous peripheral blood stem cell transplant (PBSCT) in children with relapsed or refractory Hodgkin and non-Hodgkin lymphoma (HL and NHL). Patients achieving complete remission (CR) or partial remission (PR) after 2 to 4 courses of reinduction underwent a granulocyte-colony stimulating factor (G-CSF) mobilized PBSC apheresis with a target collection dose of 5 × 10⁶ CD34(+)/kg. Those eligible to proceed received autologous PBSCT after CBV (7200 mg/m², 450-300 mg/m², 2400 mg/m²). Forty-three of 69 patients (30/39 HL, 13/30 NHL) achieved a CR/PR after reinduction. Thirty-eight patients (28 HL, 10 NHL) underwent PBSCT. All initial 6 patients who received BCNU at 450 mg/m² experienced grade III or IV pulmonary toxicity compared to none of the subsequent 32 receiving 300 mg/m² (P < .0001). The probability of overall survival (OS) at 3 years for all patients is 51% and for transplanted patients is 64%. The 3-year event-free survival (EFS) is 38% (45% for HL; 30% NHL). The 3-year EFS in transplanted patients is 66% (65% HL; 70% NHL). Initial duration of remission of ≥12 versus <12 months was associated with a significant increase in OS (3 years OS 70% versus 34%) (P = .003). BCNU at 300 mg/m(2) in a CBV regimen prior to PBSCT is well tolerated in relapsed or refractory pediatric lymphoma patients. A short duration (<12 months) of initial remission is associated with a poorer prognosis. Last, a high percentage of patients achieving a CR/PR after reinduction therapy can be salvaged with CBV and autologlous PBSCT.
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Affiliation(s)
- Richard E Harris
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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20
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Paillard C, Salmon A, Curtillet C, David A, Halle P, Cachin F, Bordigoni P, Michel G, Rousseau R, Dore E, Isfan F, Merlin E, Rochette E, Demeocq F, Kanold J. Evidence of a clinical response at one yr after reduced-intensity allogeneic hematopoietic stem cell transplantation in heavily pretreated adolescents with aggressive refractory Hodgkin's lymphoma. Pediatr Transplant 2010; 14:109-14. [PMID: 19490483 DOI: 10.1111/j.1399-3046.2009.01140.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report results of RIC AHSCT in four adolescents with aggressive refractory HL. They all received three or four lines of therapy prior to RIC-AHSCT including autografts. At the time of RIC, they were in partial response except for one patient who had progressive chemoresistant disease. The conditioning regimen consisted of fludarabin, busulfan and ATG. They all had a matched related donor. The median follow-up was 12-16-month post-allograft. All patient transplants engrafted rapidly. The median time of hospitalization was 35 days. The median time to neutrophil recovery (>or=500/muL) was 19 days. All the patients were in complete donor chimerism at day 60. Four patients developed skin (grade <or= II) acute GvHD. All responded and all are alive. Two patients are in CR, one in PR and one relapsed six months after grafting after a PR. Each of the patients in PR received two DLI. These observations, together with the responses after DLI, suggest the presence of a graft vs. lymphoma effect in patients with advanced active HL. Prospective studies are needed to identify the patients likely to benefit most from this treatment approach.
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Affiliation(s)
- C Paillard
- Centre Hospitalier et Universitaire de Clermont-Ferrand, Service de Pédiatrie B et Unité Bioclinique de Thérapie Cellulaire, Clermont-Ferrand, France.
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21
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Satwani P, Baldinger L, Freedman J, Jacobson JS, Guerra J, van de Ven C, Morris E, Garvin J, George D, Bradley MB, Bhatia M, Tallamy B, Schwartz J, Jin Z, Cairo MS. Incidence of Viral and fungal infections following busulfan-based reduced-intensity versus myeloablative conditioning in pediatric allogeneic stem cell transplantation recipients. Biol Blood Marrow Transplant 2009; 15:1587-95. [PMID: 19896083 DOI: 10.1016/j.bbmt.2009.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 08/07/2009] [Indexed: 11/25/2022]
Abstract
Reductions in the duration and nadir of neutropenia have translated into a significant decrease in bacteremia in adult recipients of allogeneic stem cell transplantation (allo-SCT) with reduced-intensity conditioning (RIC) during the first 30 days after transplantation. It remains to be determined whether RIC allo-SCT also will result in a decrease in systemic viral infections (SVIs) and invasive fungal infections (IFIs), which are more dependent on alterations in cellular immunity. We compared the incidence of SVIs and IFIs in children receiving busulfan-based RIC allo-SCT and in children receiving myeloablative conditioning (MAC) allo-SCT for various malignant and nonmalignant diseases. Allo-SCT recipients at risk for cytomegalovirus (CMV) received ganciclovir/foscarnet, and most of the patients received antifungal prophylaxis with liposomal amphotericin B until day +100. Eighty-six patients (median age, 7.5 years; 70% with malignant disease, 30% with nonmalignant disease; 80% average risk, 20% poor risk) were evaluated. The probability of developing grade II-IV acute graft-versus-host disease (aGVHD) was 29.1% (95% confidence interval [CI]=16.7%-41.6%) in RIC allo-SCT versus 40.3% (95% CI=23.9%-56.6%) in MAC allo-SCT (P=.23), and that of chronic GVHD (cGVHD) was 28.9% (95% CI=14.7%-43.0%) in RIC allo-SCT versus 28.4% (95% CI=10.5%-46.3%) in MAC allo-SCT (P=.73). The overall probability of developing an SVI was 58%, and that of developing an IFI was 15%. These probabilities did not differ significantly by conditioning intensity. In a multivariate Cox regression model, the following were identified as independent risk factors for invasive fungal infection: older age (hazard ratio [HR]=1.3; 95% CI=1.1-1.6; P=< .01), poor risk status (HR=6.5; 95% CI =1.1-37.4; P=.03), and CMV-positive recipient (high vs low CMV risk group, HR=26.7; 95% CI=3.4-210.8; P=< .01). Overall infection-related mortality was only 1.1% (1/86) for SVIs and 2.3% (2/86) for IFIs. Our data indicate that RIC allo-SCT does not carry a lower risk of SVIs and IFIs than MAC allo-SCT in pediatric recipients.
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Affiliation(s)
- Prakash Satwani
- Department of Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, New York 10032, USA
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22
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Abstract
In this issue of Blood, Claviez and colleagues report on the outcomes of 91 patients younger than 18 years of age who underwent an allogeneic bone marrow transplantation for HL between 1987 and 2005. The outcomes were reported to the European Group for Blood and Marrow Transplantation.
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Claviez A, Sureda A, Schmitz N. Haematopoietic SCT for children and adolescents with relapsed and refractory Hodgkin's lymphoma. Bone Marrow Transplant 2009; 42 Suppl 2:S16-24. [PMID: 18978738 DOI: 10.1038/bmt.2008.278] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- A Claviez
- Department of Paediatrics and BMT Unit, University Hospital of Schleswig-Holstein Campus Kiel, Kiel, Germany. a.claviez@ped iatrics.uni-kiel.de
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Hochberg J, Waxman IM, Kelly KM, Morris E, Cairo MS. Adolescent non-Hodgkin lymphoma and Hodgkin lymphoma: state of the science. Br J Haematol 2009; 144:24-40. [PMID: 19087093 DOI: 10.1111/j.1365-2141.2008.07393.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Jessica Hochberg
- Department of Pediatrics, Columbia University, New York, NY 10032, USA
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Li J, Meng X, Tao K, Dou K. Prolongation of cardiac allograft survival by syngeneic hematopoietic stem/progenitor cell transplantation in mice. Adv Ther 2008; 25:935-42. [PMID: 18758696 DOI: 10.1007/s12325-008-0091-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Organ transplantation is a rapidly developing field, being the only effective treatment for end-stage organ disease. However, the associated immunosuppressant therapy has numerous direct and indirect adverse effects. Hematopoietic stem cell transplantation (HSCT), via immune reconstitution, offers an alternative method of treatment. In this study, we determined the cardiac allograft survival in mice treated with syngeneic HSCT or hematopoietic progenitor cell transplantation (HPCT). METHODS BALB/c and C57BL/6 mice were randomly divided into three groups. Mice in Group A (n=7) were untreated while those in Group B (n=8) and C (n=7) were treated with HPCT and HSCT, respectively. Cervical heterotopic cardiac transplantation models were established in all groups and cardiac grafts were observed throughout. Regulatory T (Treg) cell expression in peripheral blood was analyzed by flow cytometry. We recorded the cardiac allograft survival time and constructed Kaplan-Meier survival curves. RESULTS The number of Treg cells in Group B was significantly higher than that in Group C (P<0.05). The survival time of mice from each group differed significantly according to Kaplan-Meier/log-rank analysis (P<0.01). A total of 62.5% of the grafts in Group B showed long-term survival (>100 days); all the mice in Group A died within 9 days, compared with 59 days in Group C. CONCLUSION We conclude that syngeneic HSCT and HPCT can prolong cardiac allograft survival in mice. These two methods could be promising ways to induce immune tolerance in future organ transplantation.
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Affiliation(s)
- Jianping Li
- Department of Hepato-biliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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26
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Abstract
Umbilical cord blood gifted to non-profit public cord blood banks is now routinely used as an alternative source of haematopoietic stem cells for allogeneic transplantation for children and adults with cancer, bone marrow failure syndromes, haemoglobinopathies and many genetic metabolic disorders. Because of the success and outcomes of public cord banking, many companies now provide private cord banking services. However, in the absence of any published transplant evidence to support autologous and non-directed family banking, commercial cord banks currently offer a superfluous service.
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Affiliation(s)
- Michael J Sullivan
- Department of Paediatrics, Children's Cancer Research Group, Children's Haematology Oncology Centre, Christchurch School of Medicine, University of Otago, 2 Riccarton Ave, Christchurch 8005, New Zealand.
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