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Blood, 3 September 2009, Vol. 114, No. 10, pp. 2060-2067.
Prepublished online as a Blood First Edition Paper on June 4, 2009; DOI 10.1182/blood-2008-11-189399.
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Submitted November 17, 2008
Accepted May 7, 2009
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
Alexander Claviez*, Carme Canals, Daan Dierickx, Jerry Stein, Isabel Badell, Andrea Pession, Stephen Mackinnon, Shimon Slavin, Jean-Hugues Dalle, Manuel Jurado Chacon, Mahmoud Sarhan, Robert Francis Wynn, Meinolf Suttorp, Giorgio Dini, Anna Sureda, and Norbert Schmitz
Department of Pediatrics and Bone Marrow Transplant Unit, University Hospital Schleswig-Holstein, Kiel, Germany
LWP Statistician, Research Institute, Hospital de la Sant Pau, Barcelona, Spain
Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
Bone Marrow Transplant Unit, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Oncology-Haematology & Cell Therapy Unit, Unversity of Bologna, Bologna, Italy
Department of Hematology, Royal Free Hospital and School of Medicine, London, United Kingdom
Department of Bone Marrow Transplantation, Hadassah University Hospital, Jerusalem, Israel
Haematology & Immunology Pediatric Unit, Hopital Robert Debre, Paris, France
Servicio de Hematologia, Hospital Universitario Virgen de las Nieves, Granada, Spain
Bone Marrow & Stem Cell Transplantation Clinic, King Hussein Cancer Centre, Amman, Jordan
Department of Pediatric Hematology, Royal Manchester Children's Hospital, Manchester, United Kingdom
Department of Pediatrics, University Hospital Carl Gustav Carus, Dresden, Germany
Institute G. Gaslini, Genova, Italy
Clinical Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Asklepios Klinik St. Georg, Hamburg, Germany
* Corresponding author; email: a.claviez{at}pediatrics.uni-kiel.de.
Ninety-one children and adolescents  18 years who received allogeneic hematopoietic stem cell transplantation (HSCT) for relapsed or refractory Hodgkin's lymphoma (HL) were analyzed. Fifty-one patients received reduced intensity conditioning (RIC), 40 patients received myeloablative conditioning (MAC). Non-relapse 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 to MAC, this was most apparent beginning 9 months after HSCT (P = .01). Progression-free survival (PFS) was 40±6% and 30±6%, 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 to MAC (P = .02). Graft-versus-host-disease did not affect relapse rate and PFS. In conclusion, children and adolescents with relapsed and refractory HL show reasonable results with allogeneic HSCT. Especially those 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 for treatment failure, additional efforts to improve disease control are necessary.
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