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Lymphoma

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

Leukemia volume 29, pages 448–455 (2015)Cite this article

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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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Acknowledgements

We thank patients and their families for participating in this study. We also thank the nursing team for their dedication and excellent care provided to our patients. This work was supported in part by grants from the Pediatric Cancer Research Foundation, Dreaming for Discovery and Cure Fund, Ashley G. Foundation, Paul Luisi Foundation, Marisa Fund and Brittany Barron Fund.

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Authors and Affiliations

  1. Department of Pediatrics, Columbia University, New York, NY, USA

    P Satwani, M Bhatia, J H Garvin, D George & J Sosna

  2. Department of Biostatistics, Columbia University, New York, NY, USA

    Z Jin

  3. Department of Pediatrics, Duke University, Durham, NC, USA

    P L Martin, M Peterson & J Kurtzberg

  4. Department of Pediatrics, Northwestern University, Chicago, IL, USA

    S Chaudhury

  5. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA

    J Talano

  6. Depatment of Pediatrics, New York Medical College, Valhalla, NY, USA

    E Morris, L Harrison, O Militano, S Foley & M S Cairo

  7. Departments of Medicine, Pathology, Microbiology and Anatomy, New York Medical College, Valhalla, NY, USA

    M S Cairo

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Correspondence to P Satwani.

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Satwani, P., Jin, Z., Martin, P. et al. 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. Leukemia 29, 448–455 (2015). https://doi.org/10.1038/leu.2014.194

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