title: High-dose melphalan, vincristine, and total-body irradiation with autologous bone marrow transplantation in children with relapsed neuroblastoma: a phase II study.
abstract: Seven children with neuroblastoma who had relapsed on or after conventional therapy (3 originally stage IV, 3 stage III, 1 stage II) were entered on a study of "massive therapy" with purged autologous bone marrow rescue. In 5 patients attempts were made to reinduce remission with alternative chemotherapy, and a partial or complete response was achieved in 3. The massive therapy regimen comprised melphalan, vincristine, and total-body irradiation. Of 6 patients with measurable disease, all showed objective response to high-dose therapy (5 partial, 1 complete remission), but the median duration of remission was only 5 months (range 1/2 to 10). One patient remains disease-free at 18 months post graft. This patient was the only one treated in second complete remission. These data confirm the high response rate achieved by high-dose melphalan, total-body irradiation regimens, but it appears unlikely that a single high-dose chemoradiotherapy procedure will cure patients after relapse, particularly if they are unresponsive to conventional salvage regimens. Such protocols may, however, have a role as consolidation in first remission. The use of double-autograft procedures is an alternative that warrants further investigation in patients with relapsed neuroblastoma.
authors.affiliation: Bone Marrow Transplant Team, Centre Léon Bérard, Paris.
authors.forename: C R
authors.initials: CR
authors.lastname: Pinkerton
authors.forename: T
authors.initials: T
authors.lastname: Philip
authors.forename: P
authors.initials: P
authors.lastname: Biron
authors.forename: D
authors.initials: D
authors.lastname: Frapazz
authors.forename: N
authors.initials: N
authors.lastname: Phillipe
authors.forename: J M
authors.initials: JM
authors.lastname: Zucker
authors.forename: J L
authors.initials: JL
authors.lastname: Bernard
authors.forename: I
authors.initials: I
authors.lastname: Philip
authors.forename: J
authors.initials: J
authors.lastname: Kemshead
authors.forename: M
authors.initials: M
authors.lastname: Favrot
mesh_terms: 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; D008558:Melphalan / Q000008:administration & dosage; D009447:Neuroblastoma / Q000473:pathology / Q000628:therapy*; D014750:Vincristine / Q000008:administration & dosage; D014916:Whole-Body Irradiation
chemical_list: D014750:Vincristine; D008558:Melphalan