Lymphomas
Lymphomas are the third most common malignancy in children and adolescents and are among the most curable of childhood cancers with modern risk-adapted chemotherapy and radiation therapy. Despite significant improvements in outcomes, 10–15 % of children a
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Lymphomas Maureen M. O’Brien, Michael J. Absalon, Thomas G. Gross, and Kara M. Kelly
Contents 10.1 10.2 10.2.1
Malignant Lymphomas in Children and Adolescents .......................................... 251
Hodgkin Lymphoma .................................. Approach to the Newly Diagnosed Patient ........................................ 10.2.2 Refractory/Relapsed Hodgkin Lymphoma ................................................... 10.2.3 Prognostic Factors at Relapse ...................... 10.2.4 General Approach to Salvage Chemotherapy .............................................. 10.2.5 Salvage Chemotherapy Regimens ............... 10.2.6 Autologous HCT in Relapsed Adult Hodgkin Lymphoma .......................... 10.2.7 Autologous HCT in Relapsed Pediatric Hodgkin Lymphoma .................................... 10.2.8 Conditioning Regimens for Autologous HCT ............................................................. 10.2.9 Radiation Therapy Following Autologous HCT .......................................... 10.2.10 Allogeneic HCT in Relapsed Hodgkin Lymphoma ................................................... 10.2.11 Novel Agents in Relapsed Hodgkin Lymphoma ................................................... 10.3 10.3.1 10.3.2
10.1
252 252 252 253 256 257 259 261 264 265 265 267
Non-Hodgkin Lymphoma.......................... 272 Approach to the Newly Diagnosed Patient with NHL ......................................... 272 Relapsed/Refractory NHL ........................... 278
References ................................................................. 282
M.M. O’Brien, MD, MS (*) • M.J. Absalon, MD, PhD Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA e-mail: [email protected]
Malignant Lymphomas in Children and Adolescents
Lymphomas are the third most common malignancy in children and adolescents, after acute leukemias and brain tumors; they account for approximately 15 % of all pediatric cancers (Howlader et al. 2012). Among children 2, 2 relapse All relapsed/refractory; 17 CR,
Table 10.3 Pediatric series of autologous HCT in Hodgkin lymphoma
2.7 years
4.2 years
4.5 years
Not reported
3.3 years
5.4 years
66 % for CR2; Not reported 52 % for ≥ 2nd relapse (6-year)
67 % (5-year) 6.6 years 59 % (10-year)
59 % (5-year)
68 % (5-year)
72 % (5-year)
76 % (5-year)
95 % (5-year)
43 % (5-year)
Median Overall survival follow-up 64 % (3-year) 3 years
262 M.M. O’Brien et al.
2011
ICE, VI
CBV
24 relapsed, 34 refractory; Not reported ESHAP 88 % chemosensitive 15 progressive disease, 14 Variable (MIED, Variable (BEAM, BuCy, early relapse, 21 late relapse Stanford V, BuMel) MOPP and derivatives, ICE, GV)
39 total, 28 All patients with PR/CR auto-HCT after 4 cycles of salvage
50
58
55 % (11-year) 3.6 years
58 % 5-year FFS [53 % for 74 % (5-year) 4.9 years primary progressive disease; [17.9 % for 83 % for early/late relapse] nonresponders to salvage therapy; 97 % for responders All patients 45
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