[High-dose chemoradiotherapy with bone marrow transplantation as a consolidation treatment of neuroblastoma. Results in 49 unselected patients with stage IV cancer and older than 1 year. Report of the LMCE neuroblastoma group].
65 consecutive children over one year of age presenting with neuroblastoma stage IV were unselectively treated with an induction regimen alternating Cis-Platinum/VM 26 and Cyclophosphamide/Adriamycin/Vincristin. After primary surgery two to four months post diagnosis, consolidation consisted of continuous Vincristin, high dose Melphalan and fractionated total body irradiation, followed by bone marrow transplantation (autologous except for 3 allogeneic). Of the 49 children transplanted up to evaluation date, 31 were in partial remission (PR) and 18 in "very good partial remission" (VGPR) or complete remission (CR) at the time of transplantation. The toxic mortality was 20% (14% early, 6% late), the relapse rate 29% and the progressive disease rate 6%. The event-free survival from graft (events being relapse, progression or death) was 33% after a median of 17 months (range: 2-45) without a significant difference between a status at transplantation of PR versus VGPR/CR. The overall actuarial progression-free survival of the complete group of children with neuroblastoma stage IV was 24% after 27 months, including 10 patients who died or relapsed before massive therapy as well as 6 children still in induction. This result must be compared with 6% survival in a similar group diagnosed at the same institutions and treated with conventional chemotherapy before the onset of this trial.
Kremens
B
B
Philip
T
T
Bernard
J L
JL
Zucker
J M
JM
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D014916:Whole-Body Irradiation
Hochdosierte Chemoradiotherapie mit Knochenmarkstransplantation als Konsolidierungsbehandlung beim Neuroblastom. Ergebnisse bei 49 unselektionierten Patienten mit Stadium IV und älter als ein Jahr. Ein Bericht von der LMCE-Neuroblastom Gruppe.