Hodgkin Lenfoma Nüks ve/veya Kemoterapi Dirençli Olgularda Hematopoetik Kök Hücre Nakli ve Yüksek Doz Kemoterapi: Tek Merkez Deneyimi

Giriş: Standart tedavi alan Hodgkin Lymphoma (HL) hastalarının yaklaşık %20’sinde hastalık dirençli seyredebilir veya tekrar edebilir. Tekrar eden/ dirençli HL’da standart tedavi yüksek doz kemoterapi ve takip eden otolog kök hücre naklidir (OKHN). Otolog KHN sonrası tekrar eden hastalarda ise allojeneik kök hücre nakli (AKHN) önemli bir kurtarma tedavisi olarak görülmektedir. Amaç: Medipol Üniversitesi Tıp Fakültesi çocuk kemik iliği nakil ünitesinde OKHN ve AKHN yapılan hastalarda sonuçları değerlendirmek. Yöntem: Tekrar eden/dirençli HL nedeniyle 2014 Kasım ile Temmuz 2019 tarihleri arasında merkezimizde OKHN yapılan 18 olgu retrospektif olarak değerlendirilmiştir. Otolog KHN sonrası hastalığı tekrar eden ve AKHN yapılan hastalarda ayrıca değerlendirilmiştir. Bulgular: Onaltı hasta halen hayattadır. Onbir hastada OKHN sonrası hastalık tekrar etmiştir. Relaps eden hastalardan 10’una AKHN yapılmıştır. Bu hastalardan üçünde tekrar görülmüş olup, sekizi nakil sonrası hayattadırlar.

Hematopoietic Stem Cell Transplantation and High Dose Chemotherapy in Recurrent and/or Chemotherapy Resistant Hodgkin Lymphoma Cases: A Single Center Experience

Background: Nearly 20% of patients with Hodgkin Lymphoma (HL) who receive standard treatment will relapse or have a refractory disease. Standard treatment for the Relapsed/Refractory (RR) HL is salvage high dose chemotherapy followed by autologous stem cell transplantation (AuSCT). Management of RR HL after AuSCT with allogeneic stem cell transplantation (ASCT) is also considered as an important salvage therapy. Objective: To describe the outcome in pediatric patients with RR HL who underwent AuHSCT and ASCT in Medipol University hematopoietic stem cell transplantation center. Method: We retrospectively evaluated 18 pediatric patients with RR HL who underwent AHSCT between November 2014 and July 2019. The evaluation of ASCT after RR HL AuSCT is also done. Results: Sixteen patients are still alive. Eleven of them relapsed after AuHSCT. AllogeneicHSCT was performed on 10 patients who relapsed. Relapse was seen in three patients after AHSCT. Eight of them are still alive.

___

  • 1. Christine Mauz-Körholz, Monika L. Metzger, Kara M, et al. Pediatric Hodgkin Lymphoma. J Clin Oncol. 2015 Sep 20;33(27):2975-85.
  • 2. Schellong G, Bramswig J, Ludwig R, et al: Combined treatment strategy in over 200 children with Hodgkin’s disease: Graduated chemotherapy, involved field irradiation with low dosage and selective splenectomy—A report of the cooperative therapy study DAL-HD-82 [in German]. Klin Pädiatr 198:137-146, 1986
  • 3. Weiner MA, Leventhal BG, Marcus R, et al: Intensive chemotherapy and low-dose radiotherapy for the treatment of advanced-stage Hodgkin’s disease in pediatric patients: A Pediatric Oncology Group study. J Clin Oncol 9:1591-1598, 1991
  • 4. Hutchinson RJ, Fryer CJ, Davis PC, et al: MOPP or radiation in addition to ABVD in the treatment of pathologically staged advanced Hodgkin’s disease in children: Results of the Children’s Cancer Group phase III trial. J Clin Oncol 16:897-906, 1998
  • 5. Schellong G, Potter R, Bramswig J, et al: High cure rates and reduced long-term toxicity in pediatric Hodgkin’s disease: The German-Austrian multicenter trial DAL-HD-90—The German-Austrian Pediatric Hodgkin’s Disease study group. J Clin Oncol 17:3736-3744, 1999
  • 6. Donaldson SS, Link MP, Weinstein HJ, et al: Final results of a prospective clinical trial with VAMP and low-dose involved-field radiation for children with low-risk Hodgkin’s disease. J Clin Oncol 25:332-337, 2007.
  • 7. Viviani S, Zinzani PL, Rambaldi A, et al. ABVD versus BEACOPP for Hodgkin’s Lymphoma When High-Dose Salvage Is Planned. New England Journal of Medicine. 2011; 365(3):203–212.
  • 8. Johnson P, Federico M, Kirkwood A, et al. Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin’s Lymphoma. New England Journal of Medicine. 2016; 374(25):2419–2429.
  • 9. Lohri A, Barnett M, Fairey RN, et al. Outcome of treatment of first relapse of Hodgkin’s disease after primary chemotherapy: identification of risk factors from the British Columbia experience 1970 to 1988. Blood. 1991; 77(10):2292–2298.
  • 10. Majhail NS, Weisdorf DJ, Defor TE, et al. Long-Term Results of Autologous Stem Cell Transplantation for Primary Refractory or Relapsed Hodgkin’s Lymphoma. Biology of Blood and Marrow Transplantation. 2006; 12(10):1065–1072.
  • 11. Satish Shanbhag, and Richard Ambinder. Hodgkin Lymphoma: a review and update on recent progress. CA Cancer J Clin. 2018 March ; 68(2): 116–132.
  • 12. Thomson KJ, Peggs KS, Smith P, et al. Superiority of reduced-intensity allogeneic transplantation over conventional treatment for relapse of Hodgkin’s lymphoma following autologous stem cell transplantation. Bone marrow transplantation. 2008; 41(9):765–770.
  • 13. Burroughs LM, O’Donnell PV, Sandmaier BM, et al. Comparison of outcomes of HLA-matched related, unrelated, or HLA-haploidentical related hematopoietic cell transplantation following nonmyeloablative conditioning for relapsed or refractory Hodgkin lymphoma. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2008; 14(11):1279–1287.
  • 14. Thomson KJ, Peggs KS, Smith P, et al. Superiority of reduced-intensity allogeneic transplantation over conventional treatment for relapse of Hodgkin’s lymphoma following autologous stem cell transplantation. Bone marrow transplantation. 2008; 41(9):765–770.
  • 15. Porter DL, Stadtmauer EA, Lazarus HM. ‘GVHD’: graft-versus-host disease or graft-versus-Hodgkin’s disease? An old acronym with new meaning. Bone marrow transplantation. 2003; 31(9):739–746.
  • 16. Sureda A, Robinson S, Canals C, et al. Reduced-Intensity Conditioning Compared With Conventional Allogeneic Stem-Cell Transplantation in Relapsed or Refractory Hodgkin’s Lymphoma: An Analysis From the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Journal of Clinical Oncology. 2008; 26(3):455–462.
  • 17. Burroughs LM, O’Donnell PV, Sandmaier BM, et al. Comparison of outcomes of HLA-matched related, unrelated, or HLA-haploidentical related hematopoietic cell transplantation following nonmyeloablative conditioning for relapsed or refractory Hodgkin lymphoma. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2008; 14(11):1279–1287.
  • 18. Moskowitz CH, Nimer SD, ZelenetzVAD, et al. A 2-step comprehensive high-dose chemoradiotherapy second-line program for relapsed and refractory Hodgkin disease:analysis by intent to treat and development of a prognostic model. Blood. 2001; 97:616–623.
  • 19. Josting A, Rudolph C, Reiser M, et al. Time intensified dexamethasone-cisplatin-cytarabine: an effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin’s disease. Annals of Oncology, 2002;13:1628–1635.
  • 20. Baetz T, Belch A, Couban S, et al. Gemcitabine, dexamethasone and cisplatin is an active and nontoxic chemotherapy regimen in relapsed or refractory Hodgkin’s disease: a phase II study by the National Cancer Institute of Canada Clinical Trials Group. Annals of Oncology, 2003;14:1762–1767.
  • 21. Proctor SJ, Jackson GH, Lennard A, et al. Strategic approach to the management of Hodgkin’s disease incorporating salvage therapy with highdose ifosfamide, etoposide and epirubicin: a Northern Region Lymphoma Group study (UK). Annals of Oncology, 2003;14: 47–50.
  • 22. Bartlett NL, Niedzwiecki D, Johnson JL, et al. Gemcitabine, vinorelbine, and pegilated liposomal doxorubicin (GVD), a salvage regimen in relapsed Hodgkin’s lymphoma: CALGB 59804. Annals of Oncology. 2007;18:1071–1079.
  • 23. Santoro A, Magagnoli M, Spina M, et al. Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin’s lymphoma. Haematologica. 2007;92:35–41.
  • 24. Labrador J, Cabrero-Calvo M, Perez-Lopez E, et al. ESHAP as salvage therapy for relapsed or refractory Hodgkin’s lymphoma. Annals of Hematology. 2014;93:1745–1753.
  • 25. Moskowitz AJ, Herrera AF, Beawen AW. Relapsed and Refractory Classical Hodgkin Lymphoma: Keeping Pace With Novel Agents and New Options for Salvage Therapy. ASCO educational book. 2019;476-485.
  • 26. Chen R, Palmer JM, Martin P, et al. Results of a multicenter phase II trial of brentuximab vedotin as second-line therapy before autologous transplantation in relapsed/refractory Hodgkin lymphoma. Biology of Blood and Marrow Transplantation, 2015;21:2136–2140.
  • 27. Alessandro Broccoli and Pier Luigi Zinzani. The role of transplantation in Hodgkin lymphoma. British Journal of Haematology. 2019;84:93–104
  • 28. Cassaday RD, Fromm J, Cowan AJ, et al. Safety and activity of brentuximab vedotin (BV) plus ifosfanide, carboplatin, and etoposide (ICE) for relapsed/refractory (Rel/Ref) classical Hodgkin lymphoma (cHL): initial results of a phase I/II study. Blood. 2016; 128:1834.
  • 29. Garcia-Sanz R, Sureda A, Gonzalez AP, et al. Brentuximab vedotin plus ESHAP (BRESHAP) is a highly effective combination for inducing remission in refractory and relapsed Hodgkin lymphoma patients prior to autologous stem cell transplant: a trial of the Spanish Group of Lymphoma and Bone Marrow Transplantation (GELTAMO). Blood 2016;128:1109.
  • 30. Hagenbeek A, Zijlstra JM, Lugtenburg P, et al. Transplant BRaVE: combining brentuximab vedotin with DHAP as salvage treatment in relapsed/refractory Hodgkin lymphoma: a hase 1 dose-escalation study. Haematologica, 2016;101:44.
  • 31. O’Connor OA, Lue JK, Sawas A, et al. Brentuximab vedotin plus bendamustine in relapsed or refractory Hodgkin’s lymphoma: an international, multicentre, singlearm, phase 1-2 trial. The Lancet. Oncology. 2018;19:257–266.
  • 32. LaCasce AS, Bociek G, Sawas A, et al. Brentuximab vedotin plus bendamustine: a highly active first salvage regimen for relapsed or refractory Hodgkin lymphoma. Blood. 2018;132:40–48.
  • 33. Brice P, Bastion Y, Divine M, et al. Analysis of prognostic factors after the first relapse of Hodgkin’s disease in 187 patients. Cancer. 1996;78:1293–1299.
  • 34. Sureda A, Constans M, Iriondo A, et al. Prognostic factors affecting long-term outcome after stem cell transplantation in Hodgkin’s lymphoma autografted after a first relapse. Annals of Oncology2015;16:625–633.
  • 35. Moskowitz CH, Nademanee A, Masszi T, et al. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantation in patients with Hodgkin’s lymphoma at risk of relapse or progression (AETHERA): a randomized, double-blind, placebo-controlled, phase 3 trial. Lancet. 2015;385:1853–1862.
  • 36. Gajevski JL, Phillips GL, Sobocinski KA, et al. Bone marrow transplants from HLA-identical siblings in advanced Hodgkin’s disease. Journal of Clinical Oncology 1996;14: 572–578.
  • 37. Sureda A, Robinson S, Canals C, et al. Reduced-intensity conditioning compared with conventional allogeneic stem-cell transplantation in relapsed or refractory Hodgkin’s lymphoma: an analysis from the lymphoma working party of the European group for Blood and Marrow Transplantation. Journal of Clinical Oncology.2008;26:455–462.
  • 38. Robinson, SP, Sureda A, Canals C, et al. Reduced intensity conditioning allogeneic stem cell transplantation for Hodgkin’s lymphoma: identification of prognostic factors predicting outcome. Haematologica. 2009;94:230–238.
  • 39. Sureda A, Canals C, Arranz R, et al. Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin’s lymphoma. Results of the HDR-ALLO study - a prospective clinical trial by the Grupo Espa~nol de Linfomas/Trasplante de M edula Osea (GELTAMO) and the Lymphoma Working Party of the European group for Blood and Marrow Transplantation. Haematologica. 2012;97:310–317.
  • 40. Raiola A, Dominietto A, Varaldo R, et al. Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin’s lymphoma. Bone Marrow Transplantation 2014;49:190– 194.
  • 41. Castagna L, Bramanti S, Devillier R, et al. Haploidentical transplantation with post-infusion cyclophosphamide in advanced Hodgkin lymphoma. Bone Marrow Transplantation. 2017;52:683–688.
  • 42. Abdalla A, Hammad M, Hafez H,et al. Outcome predictors of autologous hematopoietic stem cell transplantation in children with relapsed and refractory Hodgkin lymphoma: Single‐center experience in a lower‐ middle‐income country. Pediatric Transplantation. 2019;00: 13531
Çocuk Dergisi-Cover
  • ISSN: 1302-9940
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2000
  • Yayıncı: İstanbul Üniversitesi
Sayıdaki Diğer Makaleler

COVID-19 Salgınında Ergenlerin Sağlığının Korunması ve Sürdürülmesi: Annelerin Perspektifinden

Eyşan Hanzade UMAÇ, Ayfer AYDIN

Özofagogastroduodenoskopi Uygulanan Adolesanlarda İşlem Öncesi Eğitim Uyum ve Kaygı Düzeylerini Nasıl Etkiler?

Fatma DUMANDAĞ, Selmin KÖSE, Güzide DOĞAN

Olgu Sunumu: Kistik Fibrosisi Taklit Eden Çölyak Hastalığı

Tuba KOÇKAR, Mustafa ÇİFTÇİ, Fırat ERDOĞAN, Tufan KUTLU, Sedat OKTEM

Konjenital Böbrek ve İdrar Yolu Anomalisi Olan Çocukların Tek Merkezli Retrospektif Kohort Analizi

Duygu HACIHAMDİOĞLU

Hodgkin Lenfoma Nüks ve/veya Kemoterapi Dirençli Olgularda Hematopoetik Kök Hücre Nakli ve Yüksek Doz Kemoterapi: Tek Merkez Deneyimi

Yöntem YAMAN, Murat ELLİ, Kürşat ÖZDİLLİ, Leyla TELHAN, Nihan BAYRAM, Volkan HAZAR, Ebru TUĞRUL, Şifa ŞAHİN, Sema ANAK

Çocuklarda Çoklu Sistemik İnflamatuvar Sendrom

Yıldız EKEMEN KELEŞ, Dilek YILMAZ ÇİFTDOĞAN

“Çocuk Sağlığı ve Hastalık Profili-CHIP-AE” Yaşam Kalitesi Ölçüm Aracının 12-17 Yaş Arası Ergenler için Geçerlik ve Güvenilirliği

Nilüfer DEMİRSOY, Omur SAYLİGİL

Korkulu Rüya Anafilaksi: Tek Merkez Deneyimi

Pınar YILMAZBAŞ, Deniz ÖZÇEKER, Onur ADIGÜZEL, Özlem TERZİ

Yenidoğanda Pulmoner Hipertansiyon ve Galen Ven Anevrizması Birlikteliği

Muhammet BULUT, Dilek KÜÇÜK ALEMDAR, Kıvanç ÇELİKKALKAN, Emine TEKİN, Özge EREN, Handan AYHAN AKOĞLU, Azime BULUT, İlknur OKUR AKŞAN, Seyyit Bahaettin ÖNCÜ

Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi

Esra ÖZEK, Haluk ÇOKUĞRAŞ, Yıldız CAMCIOĞLU, Necla AKÇAKAYA