الفهرس 
bone marrow transplantationOnly 14 pages are availabe for public view
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Abstract
Malignant lymphomas are the third most common childhood malignancy and account for approximately 10% of cancers in children. Approximately 2/3 of the lymphomas diagnosed in children are NHL and the reminder are HD. The development of combination chemotherapy regimens for HD & NHL, had led to cure in a large fraction of patients. Nevertheless, a substantial proportion of lymphoma patients will fail to attain a remission or will relapse after attaining a remission. Few of these patients achieve prolonged disease-free survival with the second line conventional chemotherapy. The poor results of the conventional salvage therapy for relapsed and refractory lymphoma have led to the increasing use of HDC followed by ABMT or APBSCT for these patients. This approach is based upon the steep dose-response curves exhibited by several chemotherapeutic agents and radiation therapy against HD & NHL. The toxicity of CVP regimen used in the HDC of the present study was mild, tolerable and comparable to the conventional dose 2nd line arm. The main toxicity was neutropenic fever (71%), but it was successfully managed by combination of antibiotics, antifungals, transfusion support, and growth factors. Transplant related mortality (TRM) has decreased due to the improvements in the supportive care, the current use of PBSC, and the patient selection. TRM was 16.7% (2 deaths occurred, one was due to liver toxicity, and the other was due to bronchopneumonia). We found higher ORR for patients who received the HDC versus the conventional 2nd line treatment (91.7% versus 50% respectively) and this difference was statistically significant (P<0.03). The actuarial 2 year PFS was (33% versus 13%) in the HDC arm and the conventional arm respectively (but this difference was not statistically significant, p>0.15), while the OS showed a significant difference between the HDC arm and the conventional arm (50% versus 17%) respectively, P<0.05. 1. Haematopoietic cell transplantation has developed from a treatment of ”last resort” to an effective therapy of patients with lymphoma. Advances in the engraftment and supportive care including the utilization of haematopoietic growth factors and other supportive care measures have greatly reduced the morbidity and mortality associated with the transplantation and the duration of hospital stay to a considerable time. 2. HDC & APBSCT improves the outcome of pediatric lymphoma patients (including HD & NHL) with relapsed (1st or subsequent) or primary refractory disease. 3. The early consolidation with HDC and APBSCT can prevent the relapse and improve the survival of high intermediate risk of death of NHL patients (according to the age adjusted international prognostic index).