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

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 Ata�¹, Musa Karak�kc�², Serap Aksoylar³, Fatih Erbey⁴, Nurdan Ta�y�ld�z⁵, Alphan K�pesiz⁶, Haldun �niz⁷, Ekrem �nal², Sava� Kansoy³, G�ly�z �zt�rk⁴, Murat Elli⁸, Z�hre Kaya⁹, Emel �nal⁵, Volkan Hazar⁶, �ebnem Y�lmaz Bengoa¹⁰, G�ls�n Karasu¹¹, Didem Atay⁴, Ayhan Da�demir⁸, Hale �ren¹⁰, �lker Ko�ak⁹, M. Akif Ye�ilipek¹¹
¹G�lhane 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, �zmir, Turkey
⁴Medical Park Bah�elievler Hospital, Pediatric Bone Marrow Transplantation Unit, �stanbul, 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, �zmir, Turkey
⁸Ondokuz May�s 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 Eyl�l University Faculty of Medicine, Department of Pediatric Hematology and Bone Marrow Transplantation Unit, �zmir, Turkey
¹¹Medical Park G�ztepe Hospital, Pediatric Bone Marrow Transplantation Unit, �stanbul, 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 K�k H�cre Nakli Uygulanm�� Hodgkin Lenfomal� �ocuk ve Ad�lesanlarda Prognostik Fakt�rler ve Yeni Bir Prognostik �ndeks Modeli: T�rk Pediatrik Kemik �li�i Nakli �al��ma Grubundan �ok Merkezli �al��ma

Ama�: Relaps/refrakter Hodgkin lenfoman�n (HL) otolog hematopoetik k�k h�cre nakli (OHKHN) sonras�ndaki prognozunu g�sterecek belirte�ler ve �ocukluk �a��nda yeni bir prognostik skorlama ara�t�r�ld�.
Gere� ve Y�ntem: Bu �al��mada, Ocak 1990-Aral�k 2014 tarihleri aras�nda OHKHN uygulanan 61 hastan�n OHKHN sonras� prognozunu etkileyen fakt�rlerin sa�kal�m �zerine etkisi ara�t�r�ld�. Ayn� zamanda Ya�a G�re D�zeltilmi� Uluslararas� Prognostik �ndeks ve �ocukluk D�nemi Uluslararas� Prognostik �ndeks�lerinin (�DUP�) prognoz �zerindeki etkisi de�erlendirildi.
Bulgular: Altm�� bir hastan�n ortanca ya�� OHKHN s�ras�nda 14,8 y�l (5-20 y�l) idi. Hastalardan, 28 olguda bir relaps, 8 olguda ≥2 relaps ve 25 olguda refrakter hastal�k vard�. Kemosensitivite/kemoterapiye diren�lilik oran� 36/25 idi. Nakil �ncesi radyoterapi almamak, nakil �ncesi remisyonda olmamak, nakil sonras� beyaz kan h�cresi say�s�n�n 10x103/μL �zerinde olmas�, nakil sonras� 100. g�n pozitron emisyon tomografisi pozitifli�i, tan�da 2,5 g/dL�den d��k serum alb�min d�zeyi progresyonsuz sa�kal�m �zerinde etkili belirte�ler iken transplantasyon zaman� remisyonda olmamak, tan�da kemik ili�i pozitifli�i ve OHKHN sonras� relaps ise genel sa�kal�m �zerinde etkili parametreler olarak bulundu.
Sonu�: Relaps/refrakter HL�li �ocuklarda progresyonsuz ve genel sa�kal�m� etkileyen fakt�rler a��k�a g�sterildi. Serum laktat dehidrogenaz �st s�n�r�n� 500 IU/L olarak kullanan �DUP� prognozu g�stermede etkili bulundu. Relaps hastalarda ilk tam remisyonda OHKHN yap�lmas�n� ve tan� an�nda y�ksek prognostik skoru olan olgular�n da OHKHN a��s�ndan
de�erlendirmeye al�nmas�n� �nermekteyiz.

Anahtar Kelimeler: �ocukluk �a�� Hodgkin lenfoma, Prognoz, Otolog hematopoetik k�k h�cre nakli, Prognostik indeks

Vural Kesik, Erman Ata�, Musa Karak�kc�, Serap Aksoylar, Fatih Erbey, Nurdan Ta�y�ld�z, Alphan K�pesiz, Haldun �niz, Ekrem �nal, Sava� Kansoy, G�ly�z �zt�rk, Murat Elli, Z�hre Kaya, Emel �nal, Volkan Hazar, �ebnem Y�lmaz Bengoa, G�ls�n Karasu, Didem Atay, Ayhan Da�demir, Hale �ren, �lker Ko�ak, M. Akif Ye�ilipek. 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, T�rkiye

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