CBV conditioning and stem cell transplantation is effective in relapsed/refractory childhood lymphoma

This study examined whether the chemotherapy combination CBV was safe and effective before stem cell transplantation in children with relapsed or refractory (did not respond to treatment) non-Hodgkin lymphoma. This study concluded that this option is safe and effective for many patients.

Outcomes for childhood non-Hodgkin lymphoma (NHL) have greatly improved in recent decades. However, the outcomes for patients with relapsed disease or who have not responded to treatment still need improvement.

Stem cells are immature blood cells. In an autologous stem cell transplant (SCT), stem cells are harvested from the patient and then returned after treatment. In adult patients, SCT leads to 4 to 10 year survival rates of 42% to 70%.

High-dose chemotherapy delivered before SCT (known as conditioning) is a standard part of treatment. A chemotherapy combination of cyclophosphamide, carmustine (BCNU) and etoposide (together referred to as CBV) has been effective in adults. It is not clear if CBV is as effective in childhood NHL patients.

This study included 69 patients (39 with Hodgkin lymphoma and 30 with NHL). Patients were treated with CBV conditioning. The first 6 patients were treated with a higher dose of BCNU. The remaining patients were treated with a lower dose of BCNU. Patients who achieved a complete response (no sign of disease) or partial response (decrease in disease activity) continued to SCT. Patients were followed for an average of 3.2 years.

Three-year overall survival (time from treatment until death from any cause) was 34% for all patients. 30% of all patients had not experienced as event (such as disease relapse or progression) over 3 years.

13 NHL patients achieved a complete or partial response, and 10 went on to SCT. After SCT, 70% of patients were still alive and had not experienced progression or relapse.

Patients who achieved a complete or partial response after CBV conditioning had 3-year survival rates of 73%.

The 6 patients treated with a higher dose of BCNU experienced a lung complication. None of the patients treated with the lower dose developed this effect.

This study concluded that a lower dose of BCNU, combined with cyclophosphamide and etoposide, was well-tolerated and effective in childhood HL and NHL patients before SCT.