Allogeneic Stem Cell Transplantation Viable for Children and Adolescents
Children and adolescents with relapsed Hodgkin’s lymphoma respond well to allogeneic stem cell transplantation, according to the results of a study published in Blood.
Although children and adolescents with Hodgkin’s lymphoma have an excellent prognosis, some do relapse. These patients may benefit from stem cell transplantation, which involves the delivery of high doses of chemotherapy, followed by the infusion of stem cells, which serve to “rescue” bone marrow and hasten blood cell production and immune system recovery. Autologous stem cell transplants involve the patient’s own stem cells, whereas allogeneic stem cell transplants require the collection of donor stem cells. Allogeneic stem cell transplantation has not been widely used in children and adolescents with Hodgkin’s lymphoma because of a high rate of nonrelapse mortality (NRM), which is mainly caused by acute and/or chronic graft-versus-host disease (GVHD); GVHD occurs when the patient’s body rejects the donor cells. Researchers from the European Group for Blood and Marrow Transplantation conducted a study that involved 91 children age 18 or younger with relapsed or refractory Hodgkin’s lymphoma who were treated with an allogeneic stem cell transplant between 1987 and 2005. Fifty-one patients received reduced intensity conditioning (RIC) (lower doses of chemotherapy), and 40 patients received myeloablative conditioning (MAC) (higher doses of chemotherapy). (Of the 40 patients who had failed a prior autologous transplant, 32 received RIC.) The results of the study indicated the following:
- Non-relapse mortality at one year was 21%, with similar results for RIC or MAC.
- The two-year relapse rate was 36%.
- The five-year relapse rate was 44%.
- There were more relapses in the RIC group than the MAC group.
- Progression-free survival was 40%.
- Overall survival was 54%.
The researchers concluded that allogeneic stem cell transplantation “is a viable treatment strategy for children and adolescents with relapsed Hodgkin’s lymphoma who failed most if not all other options available.” Reference: Claviez A, Canals C, Dierickx D, et al. Allogeneic hematopoietic stem cell transplantation in children and adolescents with recurrent and refractory Hodgkin’s lymphoma: An analysis of the European Group for Blood and Marrow Transplantation. Blood. 2009; 114: 2060-2067.
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