4.2.2. Lymphomas

4.2.2.1. Hodgkin’s lymphoma

Autologous HSCT is the standard of care for patients with Hodgkin’s lymphoma in their first chemosensitive relapse or CR2 (Table 4.2) (Schmitz et al., 2002). Allogeneic transplantation with a reduced-intensity conditioning (RIC) regimen is reserved for relapse after autologous transplant or refractory Hodgkin’s lymphoma. Transplant-related mortality with RIC remains low and long-term survival is around 50% (Thomson et al., 2008).

4.2.2.2. Non-Hodgkin’s lymphoma

Five-year event-free survival (EFS) is similar for allogeneic and autologous transplants in recurrent, diffuse large B cell lymphoma (50 vs 52%), Burkitt lymphoma (31 vs 27%), and anaplastic large-cell lymphoma (46 vs 35%). However, a higher EFS has been reported for relapsed lymphoblastic lymphoma following allogeneic transplantation versus autologous transplantation (40 vs 4%) by a recent study published by Children’s Oncology Group investigators (Gross et al., 2010).

Table 4.2. Common indications for autologous HSCT in children.

Diseases Single Tandem
High risk of chemosensitive relapse Standard of care Experimental
High risk of Ewing’s sarcoma or chemosensitive relapse May be useful
Brain tumour (medulloblastoma, high-grade glioma, atypical teratoid rhabdoid tumour) May be useful, especially in young children (<3 years) in whom radiation therapy is not an option
Relapsed Hodgkin’s lymphoma Standard of care
Relapsed non-Hodgkin’s lymphoma Standard of care
Autoimmune disorder Experimental

 

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