ISSN 1866-8836
Клеточная терапия и трансплантация

Autologous hematopoietic stem cell transplantation in children and teenagers with Hodgkin’s lymphoma

Andrey V. Kozlov, Ilya V. Kazantsev, Elena V. Morozova, Tatiana V. Iuchta, Polina S. Tolkunova, Asmik G. Gevorgian, Mihail M. Kanunnikov, Kirill V. Lepik, Yuri R. Zalyalov, Elena V. Babenko, Maria A. Estrina, Natalia B. Mikhailova, Ludmila S. Zubarovskaya, Boris V. Afanasyev
Raisa Gorbacheva Memorial Institute for Children Oncology, Hematology and Transplantation at the First St. Petersburg State I. Pavlov Medical University, St. Petersburg, Russia

Download PDF version

Cellular Therapy and Transplantation (CTT)
Volume 7, Number 3
Contents 

Summary

Introduction

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%).

Results

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).

Сonclusion

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.

Keywords

Hodgkin’s lymphoma, pediatric, hematopoietic stem cell transplantation, autologous, survival rates.


Back to the list