Allogeneic hematopoietic stem cell transplantation in children and adolescents with recurrent and refractory Hodgkin lymphoma: an analysis of the European Group for Blood and Marrow Transplantation
Por:
Claviez, A, Canals, C, Dierickx, D, Stein, J, Badell, I, Pession, A, Mackinnon, S, Slavin, S, Dalle, JH, Chacon, MJ, Sarhan, M, Wynn, RF, Suttorp, M, Dini, G, Sureda, A, Schmitz, N
Publicada:
3 sep 2009
Resumen:
Ninety-one children and adolescents 18 years or younger after allogeneic hematopoietic stem cell transplantation (HSCT) for relapsed or refractory Hodgkin lymphoma (HL) were analyzed. Fifty-one patients received reduced intensity conditioning (RIC); 40 patients received myeloablative conditioning (MAC). Nonrelapse mortality (NRM) at 1 year was 21% (+/- 4%), with comparable results after RIC or MAC. Probabilities of relapse at 2 and 5 years were 36% (+/- 5%) and 44% (+/- 6%), respectively. RIC was associated with an increased relapse risk compared with MAC; most apparent beginning 9 months after HSCT (P = .01). Progression-free survival (PFS) was 40% (+/- 6%) and 30% (+/- 6%) and overall survival (OS) was 54% (+/- 6%) and 45% (+/- 6%) at 2 and 5 years, respectively. Disease status at HSCT was predictive of PFS in multivariate analysis (P < .001). Beyond 9 months, PFS after RIC was lower compared with MAC (P = .02). Graft-versus-host disease did not affect relapse rate and PFS. In conclusion, children and adolescents with recurring HL show reasonable results with allogeneic HSCT. Especially patients allografted in recent years with good performance status and chemosensitive disease show highly encouraging results (PFS: 60% +/- 27%, OS: 83% +/- 15% at 3 years). Because relapse remains the major cause of treatment failure, additional efforts to improve disease control are necessary. ( Blood. 2009; 114: 2060-2067)
Filiaciones:
Claviez, A:
Univ Hosp Schleswig Holstein, Dept Pediat, Kiel, Germany
Univ Hosp Schleswig Holstein, Bone Marrow Transplant Unit, Kiel, Germany
Canals, C:
Hosp Santa Creu & Sant Pau, Res Inst, LWP Statistician, Barcelona, Spain
Dierickx, D:
Univ Hosp Gasthuisberg, Dept Hematol, B-3000 Leuven, Belgium
Stein, J:
Schneider Childrens Med Ctr Israel, Bone Marrow Transplant Unit, Petah Tiqwa, Israel
Badell, I:
Hosp Santa Creu & Sant Pau, Dept Pediat, Barcelona, Spain
Pession, A:
Univ Bologna, Oncol Haematol & Cell Therapy Unit, Bologna, Italy
Mackinnon, S:
Royal Free Hosp & Sch Med, Dept Hematol, London, England
Slavin, S:
Hadassah Univ Hosp, Dept Bone Marrow Transplant, IL-91120 Jerusalem, Israel
Dalle, JH:
Hop Robert Debre, Haematol & Immunol Pediat Unit, F-75019 Paris, France
Chacon, MJ:
Hosp Univ Virgen Nieves, Hematol Serv, Granada, Spain
Sarhan, M:
King Hussein Canc Ctr, Bone Marrow & Stem Cell Transplantat Clin, Amman, Jordan
Wynn, RF:
Royal Manchester Childrens Hosp, Dept Pediat Hematol, Manchester M27 1HA, Lancs, England
Suttorp, M:
Univ Hosp Carl Gustav Carus, Dept Pediat, Dresden, Germany
Dini, G:
Inst G Gaslini, Genoa, Italy
Sureda, A:
Hosp Santa Creu & Sant Pau, Clin Hematol Div, Barcelona, Spain
Schmitz, N:
Asklepios Klin St Georg, Hamburg, Germany
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