Allogeneic peripheral blood stem cell transplantation following fludarabine-based conditioning in six children with advanced Hodgkin's disease

Despite high-dose chemotherapy and autografting, the outcome for patients with primary refractory Hodgkin's disease (HD) or multiple relapses remains unsatisfactory. Six pediatric patients (median age: 16 years, range: 11-19) received reduced intensity conditioning and allogeneic peripheral blood stem cell transplantation (PBSCT) after failure of stratified first-line chemotherapy, involved-field radiotherapy, and salvage chemotherapy including autologous PBSCT (two patients). For conditioning, fludarabine was combined with busulfan (8 or 12 mg/kg) and additional cyclophosphamide (three patients), or without cyclophosphamide (two patients), or melphalan (one patient). Two patients died of infections and one of progression. One patient remains in complete remission 59 months following transplantation. Two patients relapsed but responded after withdrawal of immunosuppression, chemotherapy, or donor lymphocyte infusions and are alive at 22 and 36 months post transplant, respectively. Allogeneic PBSCT, with reduced intensity conditioning, may be beneficial for selected patients with refractory HD.