High Dose Therapy (HDCT) and Autologous Haematopoietic Stem Cell Transplantation (aSCT) in Paediatric Patients with Recurrent or Refractory Hodgkin’s Disease (HD): Results and Outcome.

Objectives To evaluate the outcome of pediatric patients with refractory or relapsed Hodgkin’s Disease (HD) who undergo high dose chemotherapy (HDCT) with autologous hemopoietic stem cell rescue (aSCT) and reported to BMT Registry of Italian Pediatric Hematology-Oncology Association Group (AIEOP).

Methods From 1986 to 2004, 100 aSCT were performed in 91 pediatric patients, 45 male/35 female, with relapsed or primary refractory HD. At time of transplant the median age was 15 (6–18) years. Ten out 91 patients received a double program transplant. At the time of first transplant, 33 patients were in II CR, 35 in PR and 23 in more advanced phase of disease. First line therapy was a conventional treatment consisting of MOPP/ABVD and involved field radiotherapy for the majority of patients. Most of HDCT consisted of BCNU (38) or Thiotepa (35) based regimens, while TBI was delivered in only 2 cases. The source of stem cell was BM in 44 cases and peripheral blood in 66. A median number of 2.15 x 108/kg MNC (0.48–21.62) and 5.70 x 106/kg CD34+ cells (0.58–45.53) were infused. Pre treatment factors were analyzed by univariate analysis for prognostic significance for 5, 10 and 15-year overall survival (OS) and event free survival (EFS)

Results. After a median follow-up of 6,6 (0,1–12) years the 5, 10 and 15-year OS rates were 67.4%, 58.9% and 58.9% respectively, while 5, 10 and 15-year EFS rates were 63.7%, 54.6% and 54.6% respectively. Twenty-nine out 91 patients relapsed after a median time of 9 (2–46) months. Second CR and HDCT regimens containing BCNU can offer a better but not statistically significant 5-year EFS (83.5% and 73.8% respectively). Peripheral blood stem cell sources determined a better significant outcome (5-year EFS 76.2% vs 50.2% p= 0.024). Transplant related toxicity was moderate and 100 days TRM was 3.0%.

Discussion. More than half children with relapsed or refractory HD can be successfully treated with HDCT and aSCT, confirming the efficacy of this approach. Patients who undergo aSCT in II CR, conditioned with a BCNU containing HDCT and rescued with peripheral blood hemopoietic stem cell have a better outcome compared with those receiving any other treatment. Alternative treatment such as allogeneic SCT need to develop in patients with early relapse or chemo-resistant relapse after first line chemotherapy associated with a poorer outcome.