title: High-dose therapy and autologous hematopoietic stem-cell transplantation for recurrent or refractory pediatric Hodgkin's disease: results and prognostic indices.
abstract: OBJECTIVE
  To evaluate the outcome of pediatric patients with refractory or relapsed Hodgkin's disease (HD) who undergo high-dose therapy and autologous hematopoietic stem-cell transplantation (AHSCT).
  
  
  METHODS
  From 1989 to 2001, 41 pediatric patients with relapsed or primary refractory HD underwent high-dose therapy followed by AHSCT according to one of four autologous transplantation protocols at Stanford University Medical Center (Stanford, CA). Pretreatment factors were analyzed by univariate and multivariate analysis for prognostic significance for 5-year overall survival (OS), event-free survival (EFS), and progression-free survival (PFS).
  
  
  RESULTS
  At a median follow-up of 4.2 years (range, 0.7 to 11.9 years), the 5-year OS, EFS, and PFS rates were 68%, 53%, and 63%, respectively. Multivariate analysis determined the following three factors to be significant predictors of poor OS and EFS: extranodal disease at first relapse, presence of mediastinal mass at time of AHSCT, and primary induction failure. Two of these factors also predicted for poor PFS (extranodal disease at time of first relapse and presence of mediastinal mass at time of transplantation).
  
  
  CONCLUSIONS
  More than half of children with relapsed or refractory HD can be successfully treated with the combination of high-dose therapy and AHSCT, confirming the efficacy of this approach. Further investigation is now required to determine the optimal timing of AHSCT, as well as to develop alternative regimens for those patients with factors prognostic for poor outcome after AHSCT.
authors.affiliation: Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA 94305-5847, USA.
authors.forename: YeeYie E
authors.initials: YE
authors.lastname: Lieskovsky
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Donaldson
authors.forename: Mylin A
authors.initials: MA
authors.lastname: Torres
authors.forename: Ruby M
authors.initials: RM
authors.lastname: Wong
authors.forename: Michael D
authors.initials: MD
authors.lastname: Amylon
authors.forename: Michael P
authors.initials: MP
authors.lastname: Link
authors.forename: Rajni
authors.initials: R
authors.lastname: Agarwal
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014182:Transplantation, Autologous