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Autologous Hematopoietic Stem-Cell Transplantation for Relapsed or Refractory Hodgkin's Disease in Children and Adolescents

From the Department of Pediatrics, Section of Pediatric Bone Marrow Transplantation; Department of Internal Medicine, Section of Oncology/Hematology; and Department of Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, NE.

Address reprint requests to K. Scott Baker, MD, Pediatric Blood and Marrow Transplant Program, University of Minnesota, 420 Delaware St SE, Box 484 Mayo, Minneapolis, MN 55455; email baker084@ tc.umn.edu.

PURPOSE: To determine the treatment outcome and clinical factors that are of prognostic significance for children and adolescents with relapsed or refractory Hodgkin's disease (HD) who received treatment with high-dose chemotherapy and autologous hematopoietic stem-cell transplantation (HSCT).

PATIENTS AND METHODS: Fifty-three consecutive children and adolescents 21 years of age or younger with relapsed or refractory HD underwent HSCT.

RESULTS: At day 100 after transplantation, 29 patients (55%) were in a complete remission or maintained a continuous complete response, six (11%) had a partial response, and 11 (21%) failed to respond or had progressive disease. The failure-free survival (FFS) at 5 years was 31%, and overall survival was 43%. Twenty-one patients died of progressive HD, and nine died secondary to transplantation-related complications, including two secondary leukemias. Prognostic factors important for FFS were normal pretransplantation lactate dehydrogenase levels (5-year FFS = 42%), compared with patients with elevated LDH levels (5-year FFS = 0%) (P < .001), and disease sensitivity at the time of HSCT with FFS in untreated relapse, sensitive disease, and resistant disease 44%, 35%, and 9%, respectively (P = .06). There was no statistically significant difference in FFS or overall survival between age subgroups that were analyzed (< 13, 13 to 18, 19 to 21) or in comparison with an adult cohort.

CONCLUSION: HSCT is an effective treatment modality that can result in long-term cures and should be considered for children and adolescents with relapsed HD.

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