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
| Autor: | Zhezhen Jin, Diane George, Joanne Kurtzberg, M Peterson, Olga Militano, Julie-An Talano, Jean Sosna, James Garvin, Lauren Harrison, Sonali Chaudhury, Paul L. Martin, Sandra Foley, Erin Morris, Mitchell S. Cairo, Monica Bhatia, Prakash Satwani |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Oncology
Adult Cancer Research medicine.medical_specialty Transplantation Conditioning Adolescent medicine.medical_treatment Hematopoietic stem cell transplantation Transplantation Autologous Young Adult Autologous stem-cell transplantation HLA Antigens Recurrence hemic and lymphatic diseases Internal medicine medicine Humans Transplantation Homologous Prospective Studies Child Etoposide business.industry Lymphoma Non-Hodgkin Graft vs Tumor Effect Hematopoietic Stem Cell Transplantation Hematology medicine.disease Fetal Blood Prognosis Hodgkin Disease Fludarabine Surgery Lymphoma Transplantation Treatment Outcome Child Preschool Disease Progression business Busulfan medicine.drug |
| Zdroj: | Leukemia. 29(2) |
| ISSN: | 1476-5551 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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