High-Dose Chemotherapy in the Treatment of Malignant Lymphoma in Children

Overview

Background.
Children with primary refractory or recurrent malignant lymphoma have usually poor prognosis. Less than 10% of those, who were treated with conventional-dose regimens had survived for 2 years. In an attempt to improve the outcome for these patients, we explored the role of consolidation high-dose chemotherapy with autografting.Methods and Results. Forty-five patients with poor-prognosis lymphoma, of whom 27 were males, underwent megatherapy between January 1992 and December 1999. High-dose chemotherapy was indicated in patients with poor initial response to first-line chemotherapy (14 cases) or in the relapse (31 cases). The group consisted of 27 patients with Hodgkin’s disease and 18 patients with non-Hodgkin’s lymphoma. The median age was 14.7 years. The conditioning for Hodgkin’s disease patients contained cyclophosphamide, etoposide and busulfan or total body irradiation. Bone marrow was used as the source of haemopoietic stem cells in ten patients. Peripheral blood in twenty-eight, and both sources were used  in seven patients. After the median follow-up of 47 months, the final survival was 61%. Eleven patients died of the disease progression, four of the infectious complications, one at a car accident. Median time to relapse after the transplantation was 7,5 months.Conclusion. Further improvement of these results will require earlier transplantation, improved preparative regiments or early posttransplant immunotherapy.

Key words:
Hodgkin’s disease, non-Hodgkin’s lymphoma, high-dose chemotherapy.