title: Sequential myeloablative autologous stem cell transplantation and reduced intensity allogeneic hematopoietic cell transplantation is safe and feasible in children, adolescents and young adults with poor-risk refractory or recurrent Hodgkin and non-Hodgkin lymphoma.
abstract: The outcome of children, adolescents and young adults (CAYA) with poor-risk recurrent/refractory lymphoma is dismal (⩽30%). To overcome this poor prognosis, we designed an approach to maximize an allogeneic graft vs lymphoma effect in the setting of low disease burden. We conducted a multi-center prospective study of myeloablative conditioning (MAC) and autologous stem cell transplantation (AutoSCT), followed by a reduced intensity conditioning (RIC) and allogeneic hematopoietic cell transplantation (AlloHCT) in CAYA, with poor-risk refractory or recurrent lymphoma. Conditioning for MAC AutoSCT consisted of carmustine/etoposide/cyclophosphamide, RIC consisted of busulfan/fludarabine. Thirty patients, 16 Hodgkin lymphoma (HL) and 14 non-Hodgkin lymphoma (NHL), with a median age of 16 years and median follow-up of 5years, were enrolled. Twenty-three patients completed both MAC AutoSCT and RIC AlloHCT. Allogeneic donor sources included unrelated cord blood (n=9), unrelated donor (n=8) and matched siblings (n=6). The incidence of transplant-related mortality following RIC AlloHCT was only 12%. In patients with HL and NHL, 10 year EFS was 59.8% and 70% (P=0.613), respectively. In summary, this approach is safe, and long-term EFS with this approach is encouraging considering the poor-risk patient characteristics and the use of unrelated donors for RIC AlloHCT in the majority of cases.
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY, USA.
authors.forename: P
authors.initials: P
authors.lastname: Satwani
authors.affiliation: Department of Biostatistics, Columbia University, New York, NY, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Pediatrics, Duke University, Durham, NC, USA.
authors.forename: P L
authors.initials: PL
authors.lastname: Martin
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Bhatia
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Garvin
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY, USA.
authors.forename: D
authors.initials: D
authors.lastname: George
authors.affiliation: Department of Pediatrics, Northwestern University, Chicago IL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Chaudhury
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: J
authors.initials: J
authors.lastname: Talano
authors.affiliation: Depatment of Pediatrics, New York Medical College, Valhalla, NY, USA.
authors.forename: E
authors.initials: E
authors.lastname: Morris
authors.affiliation: Depatment of Pediatrics, New York Medical College, Valhalla, NY, USA.
authors.forename: L
authors.initials: L
authors.lastname: Harrison
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sosna
authors.affiliation: Department of Pediatrics, Duke University, Durham, NC, USA.
authors.forename: M
authors.initials: M
authors.lastname: Peterson
authors.affiliation: Depatment of Pediatrics, New York Medical College, Valhalla, NY, USA.
authors.forename: O
authors.initials: O
authors.lastname: Militano
authors.affiliation: Depatment of Pediatrics, New York Medical College, Valhalla, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Foley
authors.affiliation: Department of Pediatrics, Duke University, Durham, NC, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kurtzberg
authors.affiliation: 1] Depatment of Pediatrics, New York Medical College, Valhalla, NY, USA [2] Departments of Medicine, Pathology, Microbiology and Anatomy, New York Medical College, Valhalla, NY, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Cairo
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005312:Fetal Blood / Q000166:cytology; D020350:Graft vs Tumor Effect; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000276:immunology / Q000628:therapy*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000276:immunology / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006680:HLA Antigens