Prognostic Factors and a New Prognostic Index Model for Children and Adolescents with Hodgkin’s Lymphoma Who Underwent Autologous Hematopoietic Stem Cell Transplantation: A Multicenter Study of the Turkish Pediatric Bone Marrow Transplantation Study [Turk J Hematol]
Turk J Hematol. 2016; 33(4): 265-272 | DOI: 10.4274/tjh.2015.0280  

Prognostic Factors and a New Prognostic Index Model for Children and Adolescents with Hodgkin’s Lymphoma Who Underwent Autologous Hematopoietic Stem Cell Transplantation: A Multicenter Study of the Turkish Pediatric Bone Marrow Transplantation Study

Vural Kesik1, Erman Ataş1, Musa Karakükcü2, Serap Aksoylar3, Fatih Erbey4, Nurdan Taçyıldız5, Alphan Küpesiz6, Haldun Öniz7, Ekrem Ünal2, Savaş Kansoy3, Gülyüz Öztürk4, Murat Elli8, Zühre Kaya, Ülker Koçak9, Emel Ünal5, Volkan Hazar6, Şebnem Yılmaz Bengoa10, Gülsün Karasu, Akif Yeşilipek11, Didem Atay4, Ayhan Dağdemir8, Hale Ören10
1Gülhane Training and Research Hospital Clinic of Pediatric Oncology, Ankara, Turkey
2Erciyes University Faculty of Medicine, Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation Unit, Kayseri, Turkey
3Ege University Faculty of Medicine, Department of Pediatric Oncology and Bone Marrow Transplantation Unit, İzmir, Turkey
4Medical Park Bahçelievler Hospital, Pediatric Bone Marrow Transplantation Unit, İstanbul, Turkey
5Ankara University Faculty of Medicine, Department of Pediatric Oncology and Bone Marrow Transplantation Unit, Ankara, Turkey
6Akdeniz University Faculty of Medicine, Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation Unit, Antalya, Turkey
7Tepecik Training and Research Hospital, Clinic of Pediatric Oncology and Bone Marrow Transplantation Unit, İzmir, Turkey
8Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Oncology and Bone Marrow Transplantation Unit, Samsun, Turkey
9Gazi University Faculty of Medicine, Department of Pediatric Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
10Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology and Bone Marrow Transplantation Unit, İzmir, Turkey
11Medical Park Göztepe Hospital, Pediatric Bone Marrow Transplantation Unit, İstanbul, Turkey

Objective: The prognostic factors and a new childhood prognostic index after autologous hematopoietic stem cell transplantation (AHSCT) in patients with relapsed/refractory Hodgkin’s lymphoma (HL) were evaluated.
Materials and Methods: The prognostic factors of 61 patients who underwent AHSCT between January 1990 and December 2014 were evaluated. In addition, the Age-Adjusted International Prognostic Index and the Childhood International Prognostic Index (CIPI) were evaluated for their impact on prognosis.
Results: The median age of the 61 patients was 14.8 years (minimummaximum: 5-20 years) at the time of AHSCT. There were single relapses in 28 patients, ≥2 relapses in eight patients, and refractory disease in 25 patients. The chemosensitivity/chemorefractory ratio was 36/25. No pretransplant radiotherapy, no remission at the time of transplantation, posttransplant white blood cell count over 10x103/ μL, posttransplant positron emission tomography positivity at day 100, and serum albumin of <2.5 g/dL at diagnosis were correlated with progression-free survival. No remission at the time of transplantation, bone marrow positivity at diagnosis, and relapse after AHSCT were significant parameters for overall survival.
Conclusion: The major factors affecting the progression-free and overall survival were clearly demonstrated. A CIPI that uses a lactate dehydrogenase level of 500 IU/L worked well for estimating the prognosis. We recommend AHSCT at first complete remission for relapsed cases, and it should also be taken into consideration for patients with high prognostic scores at diagnosis.

Keywords: Childhood Hodgkin’s lymphoma, Prognosis, Autologous hematopoietic stem cell transplantation, Prognostic index


Otolog Hematopoetik Kök Hücre Nakli Uygulanmış Hodgkin Lenfomalı Çocuk ve Adölesanlarda Prognostik Faktörler ve Yeni Bir Prognostik İndeks Modeli: Türk Pediatrik Kemik İliği Nakli Çalışma Grubundan Çok Merkezli Çalışma

Vural Kesik1, Erman Ataş1, Musa Karakükcü2, Serap Aksoylar3, Fatih Erbey4, Nurdan Taçyıldız5, Alphan Küpesiz6, Haldun Öniz7, Ekrem Ünal2, Savaş Kansoy3, Gülyüz Öztürk4, Murat Elli8, Zühre Kaya, Ülker Koçak9, Emel Ünal5, Volkan Hazar6, Şebnem Yılmaz Bengoa10, Gülsün Karasu, Akif Yeşilipek11, Didem Atay4, Ayhan Dağdemir8, Hale Ören10
1Gülhane Training and Research Hospital Clinic of Pediatric Oncology, Ankara, Turkey
2Erciyes University Faculty of Medicine, Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation Unit, Kayseri, Turkey
3Ege University Faculty of Medicine, Department of Pediatric Oncology and Bone Marrow Transplantation Unit, İzmir, Turkey
4Medical Park Bahçelievler Hospital, Pediatric Bone Marrow Transplantation Unit, İstanbul, Turkey
5Ankara University Faculty of Medicine, Department of Pediatric Oncology and Bone Marrow Transplantation Unit, Ankara, Turkey
6Akdeniz University Faculty of Medicine, Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation Unit, Antalya, Turkey
7Tepecik Training and Research Hospital, Clinic of Pediatric Oncology and Bone Marrow Transplantation Unit, İzmir, Turkey
8Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Oncology and Bone Marrow Transplantation Unit, Samsun, Turkey
9Gazi University Faculty of Medicine, Department of Pediatric Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
10Dokuz Eylül University Faculty of Medicine, Department of Pediatric Hematology and Bone Marrow Transplantation Unit, İzmir, Turkey
11Medical Park Göztepe Hospital, Pediatric Bone Marrow Transplantation Unit, İstanbul, Turkey

Amaç: Relaps/refrakter Hodgkin lenfomanın (HL) otolog hematopoetik kök hücre nakli (OHKHN) sonrasındaki prognozunu gösterecek belirteçler ve çocukluk çağında yeni bir prognostik skorlama araştırıldı.
Gereç ve Yöntem: Bu çalışmada, Ocak 1990-Aralık 2014 tarihleri arasında OHKHN uygulanan 61 hastanın OHKHN sonrası prognozunu etkileyen faktörlerin sağkalım üzerine etkisi araştırıldı. Aynı zamanda Yaşa Göre Düzeltilmiş Uluslararası Prognostik İndeks ve Çocukluk Dönemi Uluslararası Prognostik İndeks’lerinin (ÇDUPİ) prognoz üzerindeki etkisi değerlendirildi.
Bulgular: Altmış bir hastanın ortanca yaşı OHKHN sırasında 14,8 yıl (5-20 yıl) idi. Hastalardan, 28 olguda bir relaps, 8 olguda ≥2 relaps ve 25 olguda refrakter hastalık vardı. Kemosensitivite/kemoterapiye dirençlilik oranı 36/25 idi. Nakil öncesi radyoterapi almamak, nakil öncesi remisyonda olmamak, nakil sonrası beyaz kan hücresi sayısının 10x103/μL üzerinde olması, nakil sonrası 100. gün pozitron emisyon tomografisi pozitifliği, tanıda 2,5 g/dL’den düşük serum albümin düzeyi progresyonsuz sağkalım üzerinde etkili belirteçler iken transplantasyon zamanı remisyonda olmamak, tanıda kemik iliği pozitifliği ve OHKHN sonrası relaps ise genel sağkalım üzerinde etkili parametreler olarak bulundu.
Sonuç: Relaps/refrakter HL’li çocuklarda progresyonsuz ve genel sağkalımı etkileyen faktörler açıkça gösterildi. Serum laktat dehidrogenaz üst sınırını 500 IU/L olarak kullanan ÇDUPİ prognozu göstermede etkili bulundu. Relaps hastalarda ilk tam remisyonda OHKHN yapılmasını ve tanı anında yüksek prognostik skoru olan olguların da OHKHN açısından
değerlendirmeye alınmasını önermekteyiz.

Anahtar Kelimeler: Çocukluk çağı Hodgkin lenfoma, Prognoz, Otolog hematopoetik kök hücre nakli, Prognostik indeks


Vural Kesik, Erman Ataş, Musa Karakükcü, Serap Aksoylar, Fatih Erbey, Nurdan Taçyıldız, Alphan Küpesiz, Haldun Öniz, Ekrem Ünal, Savaş Kansoy, Gülyüz Öztürk, Murat Elli, Zühre Kaya, Ülker Koçak, Emel Ünal, Volkan Hazar, Şebnem Yılmaz Bengoa, Gülsün Karasu, Akif Yeşilipek, Didem Atay, Ayhan Dağdemir, Hale Ören. Prognostic Factors and a New Prognostic Index Model for Children and Adolescents with Hodgkin’s Lymphoma Who Underwent Autologous Hematopoietic Stem Cell Transplantation: A Multicenter Study of the Turkish Pediatric Bone Marrow Transplantation Study. Turk J Hematol. 2016; 33(4): 265-272

Corresponding Author: Vural Kesik, Türkiye


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