Ozuah Nmazuo W, Dahmoush Hisham M, Grant Frederick D, Lehmann Leslie E, LaCasce Ann S, Billett Amy L, Margossian Steven P
Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts.
Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California.
Pediatr Blood Cancer. 2018 Jan;65(1). doi: 10.1002/pbc.26707. Epub 2017 Jul 11.
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.
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).
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).
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.
移植前功能成像（FI），尤其是阴性正电子发射断层扫描（PET），是复发或难治性霍奇金淋巴瘤（HL）成人患者预后的有力预测指标，但儿科数据有限。
回顾性分析了在单一机构接受自体移植的49例连续儿科患者的病历。所有患者在移植前均进行了镓或PET扫描，并接受了卡莫司汀、依托泊苷、阿糖胞苷和美法仑（BEAM）预处理。对PET检查结果为阳性（评分≥4）的患者进行回顾性Deauville评分。
49例患者（中位年龄16.2岁）中，41例（84%）在一线至四线挽救治疗后且中位接受两个挽救周期后移植前FI为阴性，8例（16%）移植前FI为阳性。18例患者（37%）接受了移植后放疗。中位随访46个月时，45例患者（92%）存活且无疾病，有3例非复发死亡，仅1例复发死亡（Deauville评分为5）。整个队列的4年无进展生存率（PFS）为92%（95%置信区间[CI]：78 - 97），基于移植前疾病状态的PFS在FI阴性组为95%（95% CI：82 - 99%），而FI阳性组为75%（95% CI：31 - 93）（P = 0.057）。
我们的分析显示复发/难治性HL儿童和青少年的预后良好。复发病例太少，无法确定移植前代谢状态的预测价值，但移植前FI为阴性的复发/难治性HL儿科患者生存率极佳。
