Evidence of a clinical response at one yr after reduced-intensity allogeneic hematopoietic stem cell transplantation in heavily pretreated adolescents with aggressive refractory Hodgkin's lymphoma.

We report results of RIC AHSCT in four adolescents with aggressive refractory HL. They all received three or four lines of therapy prior to RIC-AHSCT including autografts. At the time of RIC, they were in partial response except for one patient who had progressive chemoresistant disease. The conditioning regimen consisted of fludarabin, busulfan and ATG. They all had a matched related donor. The median follow-up was 12-16-month post-allograft. All patient transplants engrafted rapidly. The median time of hospitalization was 35 days. The median time to neutrophil recovery (>or=500/muL) was 19 days. All the patients were in complete donor chimerism at day 60. Four patients developed skin (grade <or= II) acute GvHD. All responded and all are alive. Two patients are in CR, one in PR and one relapsed six months after grafting after a PR. Each of the patients in PR received two DLI. These observations, together with the responses after DLI, suggest the presence of a graft vs. lymphoma effect in patients with advanced active HL. Prospective studies are needed to identify the patients likely to benefit most from this treatment approach. (c) 2009 John Wiley & Sons A/S.