Claviez A, Sureda A, Schmitz N
Department of Paediatrics and BMT Unit, University Hospital of Schleswig-Holstein Campus Kiel, Kiel, Germany. a.claviez@ped iatrics.uni-kiel.de
Bone Marrow Transplant. 2008 Oct;42 Suppl 2:S16-24. doi: 10.1038/bmt.2008.278.
Despite the generally excellent prognosis of children and adolescents with Hodgkin's lymphoma (HL), approximately 15% of patients relapse. Salvage therapy options include further chemo-radiotherapy and autologous or allogeneic haematopoietic SCT (HSCT). Autologous HSCT following high-dose chemotherapy, the standard treatment for adult patients with relapsed HL, is also effective in paediatric patients, but randomized trials showing its superiority to conventional therapy are lacking. Although patients with late relapse (>12 months after completion of therapy) may be cured with conventional therapy, those with progressive disease or early relapse (3-12 months) are considered candidates for autologous HSCT. According to patient selection criteria, overall and disease-free survival rates after autologous HSCT are 43-95% and 31-70%, respectively. Short time to relapse and refractory disease at the time of autologous HSCT remain the most important risk factors. Data on allogeneic HSCT in children with HL are scarce. Broader use has been hampered for a long time mainly by high non-relapse mortality, offsetting the advantage of a graft-vs-lymphoma effect. Data suggest that young patients with recurring disease following autologous HSCT, as well as some patients with multiple relapses and selected patients with refractory lymphoma, might benefit from allogeneic HSCT, but relapse remains the major challenge.
尽管儿童和青少年霍奇金淋巴瘤（HL）的总体预后通常良好，但仍有大约15%的患者会复发。挽救治疗方案包括进一步的放化疗以及自体或异基因造血干细胞移植（HSCT）。大剂量化疗后的自体HSCT是成人复发HL患者的标准治疗方法，在儿科患者中也有效，但缺乏显示其优于传统治疗的随机试验。虽然晚期复发（治疗结束后>12个月）的患者可能通过传统治疗治愈，但疾病进展或早期复发（3 - 12个月）的患者被认为是自体HSCT的候选者。根据患者选择标准，自体HSCT后的总生存率和无病生存率分别为43% - 95%和31% - 70%。自体HSCT时复发时间短和难治性疾病仍然是最重要的危险因素。HL患儿异基因HSCT的数据很少。长期以来，更广泛的应用主要受到高非复发死亡率的阻碍，抵消了移植物抗淋巴瘤效应的优势。数据表明，自体HSCT后复发的年轻患者，以及一些多次复发的患者和部分难治性淋巴瘤患者，可能从异基因HSCT中获益，但复发仍然是主要挑战。
