Intensive chemotherapy with hematopoietic stem-cell support for children with recurrent or refractory NHL.
BACKGROUND
Children with refractory or recurrent NHL are generally thought to have a poor prognosis. Those with chemosensitive disease are usually considered for an intensification phase, with either autologous or allogeneic hematopoietic stem-cell transplantation (HSCT).


METHODS
From 1990 to 2001 we performed 24 HSCTs in 22 children with refractory (n = 8), recurrent (n = 13), or high-risk in first CR (n = 1) NHL. Among the HSCTs, 19 were autologous and five were allogeneic.


RESULTS
In two children, allogeneic HSCT was performed after failing autologous HSCT. The histologic subtypes comprised large cell, (n = 13), Burkitt's lymphoma (n = 5) and lymphoblastic (n = 4). Among the cases of primary relapse, 10 occurred during therapy and three occurred after completing initial therapy. Among the 22 children in this series, two died of transplant-related toxicity and nine died of progressive disease or relapse after transplant. Among the 11 children who are alive and disease-free, 10 had non-lymphoblastic histology and one had lymphoblastic disease; one relapsed after autologous HSCT, but was successfully salvaged with multi-agent chemotherapy and involved-field irradiation. Among the 22 initial transplanted cases, 10 of 19 children with chemosensitive disease before transplantation and one of three with chemoresistant disease are currently alive and disease-free.


CONCLUSIONS
Intensive chemotherapy followed by hematopoietic stem-cell support is an effective strategy for children with chemosensitive recurrent non-lymphoblastic NHL.
Sandlund
J T
JT
Department of Hematology/Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
Bowman
L
L
Heslop
H E
HE
Krance
R
R
Mahmoud
H
H
Pui
C -H
C-
Hale
G
G
Benaim
E
E
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome