Pretransplant functional imaging and outcome in pediatric patients with relapsed/refractory Hodgkin lymphoma undergoing autologous transplantation

Pediatr Blood Cancer. 2018 Jan;65(1). doi: 10.1002/pbc.26707. Epub 2017 Jul 11.

Abstract

Background: Pretransplant functional imaging (FI), particularly a negative positron emission tomography (PET), is a strong predictor of outcome in adults with relapsed or refractory Hodgkin lymphoma (HL), but data in pediatrics are limited.

Methods: The medical records of 49 consecutive pediatric patients, who received autologous transplant at a single institution, were retrospectively analyzed. All patients had either gallium or PET scan before transplant and were conditioned with carmustine, etoposide, cytarabine, and melphalan (BEAM). Deauville scores were retrospectively assigned for patients with PET (score ≥ 4 positive).

Results: Of the 49 patients (median age, 16.2 years), 41 (84%) were pretransplant FI negative and eight (16%) were pretransplant FI positive, after first- to fourth-line salvage therapy, and a median of two salvage cycles. Eighteen patients (37%) received posttransplant radiation. At a median follow up of 46 months, 45 patients (92%) were alive and disease free, and there were three nonrelapse deaths and only one relapse death (Deauville score of 5). The 4-year progression-free survival (PFS) for the entire cohort was 92% (95% confidence interval [CI]: 78-97), and PFS based on pretransplant disease status was 95% (95% CI: 82-99%) in the negative FI group versus 75% (95% CI: 31-93) if positive FI (P = 0.057).

Conclusion: Our analysis revealed outstanding outcomes for children and adolescents with relapsed/refractory HL. There were too few relapses to identify the predictive value of pretransplant metabolic status, but pediatric patients with relapsed/refractory HL and a negative pretransplant FI had excellent survival.

Keywords: FDG-PET; Hodgkin lymphoma; autologous transplantation; functional imaging; relapse.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Autografts
  • Carmustine / administration & dosage
  • Child
  • Cytarabine / administration & dosage
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Hodgkin Disease* / diagnostic imaging
  • Hodgkin Disease* / mortality
  • Hodgkin Disease* / therapy
  • Humans
  • Male
  • Melphalan / administration & dosage
  • Podophyllotoxin / administration & dosage
  • Positron-Emission Tomography*
  • Preoperative Care*
  • Retrospective Studies
  • Stem Cell Transplantation*
  • Survival Rate

Substances

  • Cytarabine
  • Podophyllotoxin
  • Melphalan
  • Carmustine

Supplementary concepts

  • BEAM protocol