Autologous Peripheral Blood Stem Cell Transplantation in Children with Refractory or Relapsed Lymphoma: Results of Children’s Oncology Group Study A5962

• Published in: Biology of blood and marrow transplantation 2011-02, Vol.17 (2), p.249-258
• Main Authors: Harris, Richard E, Termuhlen, Amanda M, Smith, Lynette M, Lynch, James, Henry, Michael M, Perkins, Sherrie L, Gross, Thomas G, Warkentin, Phyllis, Vlachos, Adrianna, Harrison, Lauren, Cairo, Mitchell S
• Format: Article
• Language: English
• Subjects: Adolescent; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Autologous transplant; Carmustine - adverse effects; Carmustine - therapeutic use; CBV; Child; Child, Preschool; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Drug Resistance, Neoplasm; Etoposide - adverse effects; Etoposide - therapeutic use; Female; Hematology, Oncology and Palliative Medicine; Hematopoietic Stem Cell Mobilization; Hodgkin Disease - drug therapy; Hodgkin Disease - therapy; Humans; Lung Diseases - chemically induced; Lymphoma; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - therapy; Male; NHL; PBSCT; Peripheral Blood Stem Cell Transplantation - adverse effects; Peripheral Blood Stem Cell Transplantation - mortality; Recurrence; Remission Induction - methods; Salvage Therapy - adverse effects; Transplantation Conditioning - adverse effects; Transplantation Conditioning - methods; Transplantation Conditioning - mortality; Transplantation, Autologous; Young Adult
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2010.07.002

This prospective study was designed to determine the safety and efficacy of cyclophosphamide, BCNU, and etoposide (CBV) conditioning and autologous peripheral blood stem cell transplant (PBSCT) in children with relapsed or refractory Hodgkin and non-Hodgkin lymphoma (HL and NHL). Patients achieving complete remission (CR) or partial remission (PR) after 2 to 4 courses of reinduction underwent a granulocyte-colony stimulating factor (G-CSF) mobilized PBSC apheresis with a target collection dose of 5 × 106 CD34+ /kg. Those eligible to proceed received autologous PBSCT after CBV (7200 mg/m2 , 450-300 mg/m2 , 2400 mg/m2 ). Forty-three of 69 patients (30/39 HL, 13/30 NHL) achieved a CR/PR after reinduction. Thirty-eight patients (28 HL, 10 NHL) underwent PBSCT. All initial 6 patients who received BCNU at 450 mg/m2 experienced grade III or IV pulmonary toxicity compared to none of the subsequent 32 receiving 300 mg/m2 ( P  < .0001). The probability of overall survival (OS) at 3 years for all patients is 51% and for transplanted patients is 64%. The 3-year event-free survival (EFS) is 38% (45% for HL; 30% NHL). The 3-year EFS in transplanted patients is 66% (65% HL; 70% NHL). Initial duration of remission of ≥12 versus