Outcomes of autologous stem cell transplantation with CEAM conditioning in relapsed or refractory hodgkin's lymphoma

Background: Despite the generally excellent prognosis of children and adolescents with Hodgkin's lymphoma, approximately 20% of the patients relapse. High-dose chemotherapy, followed by autologous stem cell transplantation (ASCT), is a recognized treatment option for patients with relapsed Hodgkin's lymphoma. This study evaluated the results and outcome of noncryopreserved autologous stem cell transplantation of 32 patients with Hodgkin's lymphoma. Methods: Thirty-two patients, aged between 4 and 25 years (median=13.5 y, M/F=20/12), with relapsed, refractory, or poor prognosis Hodgkin's disease underwent ASCT in our hospital (from 2012 to 2016). Status at transplantation was: 2nd complete remission in 16, further complete remission (complete remission >2) in 13, and partial remission in 3. All the patients received chemotherapy-based conditioning regimens: cyclophosphamide, carmustine, and etoposide (CBV): 6, CCNU (200 mg/m2) day-3, etoposide (800 mg/m2) days-3 and-2, cytarabine (1000 mg/m2) days-3 and-2, and melphalan (140 mg/m2) day-1 (CEAM). The peripheral blood of 24 patients was the source of progenitor cells in the 32 patients. Results: The median mononuclear cell dose was 5.5×108/ kg. The median time to reach an absolute neutrophil count greater than 0.5×109/L was 13 days, and the median time to a platelet count greater than 20×109 was 16 days. Transplantation-related mortality at 100 days did not occur. With a median follow-up of 39 months (4-48 mon) after transplantation, the event-free survival rate was 84%. Conclusion: High-dose therapy with stem cell rescue can lead to durable remissions in children and adolescents with advanced Hodgkin's disease. Our analysis suggests that these regimens (CEAM and CBV) are feasible in pediatric patients with acceptable engraftment.