Autologous peripheral blood stem cell transplantation in children with non-Hodgkin's lymphoma: A report from the Korean society of pediatric hematology-oncology.
Recent development of stratified chemotherapeutic regimens has rapidly improved the survival rate of non-Hodgkin's lymphoma (NHL) of childhood. Despite these improvements, the outcome for children with recurrent or refractory NHL remains dismal. We explored the use of high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (HDC/PBSCT) for children with either refractory or recurrent NHL, and we evaluated various factors influencing outcome of HDC/PBSCT. Thirty-three patients underwent HDC/PBSCT in 11 institutes were enrolled. All patients had refractory or recurrent NHL. Sex, stage at diagnosis, histologic subtype (lymphoblastic, Burkitt's, and large-cell lymphoma), LDH level at diagnosis, disease status at transplantation, and preparative regimens for HDC/PBSCT were explored. In regard to the patients, six had Burkitt's lymphoma, 13 had lymphoblastic lymphoma, and 14 had large-cell lymphoma. The 2-year event-free survival (EFS) was 59.1+/-9.3%. The EFS for Burkitt's, lymphoblastic, and large-cell lymphoma was 66.7+/-27.2, 50.5+/-14.8, and 82.1+/-11.7%, respectively. In comparison with lymphoblastic and non-lymphoblastic lymphoma, the relative risk for lymphoblastic lymphoma was higher than the others (P = 0.037). EFS between anaplastic large-cell and diffuse large-cell lymphoma was 100 and 55.6+/-24.9%, respectively (P = 0.106). Status at transplantation was the most predictive factor for the survival after HDC/PBSCT (EFS for CR 70.8+/-9.5% vs non-CR 20.0+/-17.9%, P = 0.008). Transplantation-related complications were minimal, and infection was the most prevalent complication. HDC/PBSCT is considered applicable to recurrent or refractory pediatric NHL patients safely and it could replace conventional chemotherapy. In this study, children with CR status at the time of HDC/PBSCT showed higher survival rate. However, refractory or recurrent lymphoblastic lymphoma patients showed dismal results. Therefore, new therapeutic modalities may be needed for this group of NHL patients.
Won
Sung Chul
SC
Department of Pediatrics, School of Medicine, Yonsei University, 134 Sinchon-dong, Seodaemun-gu, Seoul, 120-752, South Korea.
Han
Jung Woo
JW
Kwon
Seung Yeon
SY
Shin
Hee-Young
HY
Ahn
Hyo-Seop
HS
Hwang
Tae Ju
TJ
Yang
Woo Ick
WI
Lyu
Chuhl Joo
CJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007723:Korea; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy*; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation; D012189:Retrospective Studies; D016879:Salvage Therapy; D013534:Survival; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome