Autologous hematopoietic cell transplantation for the treatment of relapsed/refractory pediatric, adolescent, and young adult Hodgkin lymphoma: a single institutional experience.

Pediatric, adolescent, and young adult patients with relapsed or refractory Hodgkin lymphoma receive multimodal therapy, including autologous hematopoietic cell transplantation (AutoHCT). Despite aggressive therapy, historical outcomes for this patient population have been poor. This paper describes a single institutional experience utilizing AutoHCT in 74 patients treated from 1988-2015. Our results demonstrate significantly improved outcomes over time. Compared with patients treated in the earlier era (1988-2001), 5-year overall survival improved from 62.5 ± 9.6% to 91.8 ± 4.4% (p < 0.001) and event free survival improved from 41.7 ± 9.6% to 87.7 ± 5.3% (I < 0.001) for patients treated in a later era (2002-2015). Improvements in survival are multifactorial, including reductions in both relapse and nonrelapse mortality. Further investigation is needed to determine the role of AutoHCT in a modern treatment cohort that includes frequent use of targeted immunotherapies. In addition, as the use and availability of effective novel therapeutics increases for this patient population there may be an opportunity for the reduction of standard cytotoxic therapies, including in AutoHCT preparative regimens, thereby mitigating late effects.

Outcomes and complications after splenectomy for hematologic disorders.

BACKGROUND: Splenectomy is generally a second-line therapy in patients with immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AHA) refractory to medical therapy. Our objective was to evaluate outcomes after splenectomy for these disorders. METHODS: A retrospective review of the medical records of patients who underwent splenectomy for ITP or AHA from January 1, 1996, to December 31, 2010 was completed. RESULTS: Sixty patients met the study criteria: 45 with ITP and 15 with AHA. The mean age was 49.4 ± 21.7 years; 63% were women. Initially, 91% and 93% of ITP and AHA patients experienced a complete response (P = .999); however, 17% of ITP and 29% of AHA patients relapsed (P = .443). Sixty-four percent of patients responded after relapse for a complete response rate of 85% (82% in ITP and 93% in AHA, P = .427). Thirty-day and long-term complication rates were 10% and 5%, respectively. There were no splenectomy-related 30-day mortalities. CONCLUSIONS: Splenectomy for ITP and AHA resulted in favorable response rates with low morbidity and is an effective adjunct in the management course of patients failing to achieve or sustain responses with medical therapy.