22.214.171.124. 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).
126.96.36.199. 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.
|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|