NYMC Faculty Publications

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

Author Type(s)

Faculty

DOI

10.1038/leu.2014.194

Journal Title

Leukemia

First Page

448

Last Page

455

Document Type

Article

Publication Date

2-1-2015

Department

Pediatrics

Keywords

Adolescent, Adult, Child, Child, Preschool, Disease Progression, Fetal Blood, Graft vs Tumor Effect, HLA Antigens, Hematopoietic Stem Cell Transplantation, Hodgkin Disease, Humans, Lymphoma, Non-Hodgkin, Prognosis, Prospective Studies, Recurrence, Transplantation Conditioning, Transplantation, Autologous, Transplantation, Homologous, Treatment Outcome, Young Adult

Disciplines

Medicine and Health Sciences

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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