[High-dose chemotherapy, G-CSF and the use of peripheral blood progenitor cells in patients with poor-prognosis neuroblastoma].
In the past decade there has been an increasing use of high dose of chemo-radiotherapy in the treatment of poor prognosis solid tumors of childhood. The autologous bone marrow transplantation is the most used technique for circumventing the infectious and haemorrhagic complications occurring in the prolonged period of myelotoxicity. The faster recovery assured by the peripheral blood progenitor cells (PBPC) makes this procedure an attractive alternative. The advent of new apheretic modalities and the use of combinations of active antineoplastic drugs with various growth factors, such as G-CSF, GM-CSF and IL-3, has allowed to collect and concentrate the mononuclear fraction of peripheral blood leukocytes. The optimal timing for the collection is a crucial point and the utilization of flow cytometry for the determinations of circulating CD34+ cells in the peripheral blood is so far the best indicator for successful apheresis. The authors describe their experience in 16 children affected by poor prognosis neuroblastoma who had undergone high dose chemotherapy followed by G-CSF administration and PBPC collection. The details of apheretic techniques and the characteristics of conditioning regimen and haematologic recovery after PBPC reinfusion are also presented.
Dallorso
S
S
IV Divisione di Pediatria, Unità di Trapianto Midollo Osseo, Istituto G. Gaslini, Genova, Italia.
Rivabella
L
L
Martinengo
M
M
Puzzo
A
A
Scarso
L
L
Dini
G
G
Lanino
E
E
Floris
R
R
Castagnola
E
E
Franchini
E
E
D015703:Antigens, CD / Q000097:blood; D018952:Antigens, CD34; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007223:Infant; D007937:Leukapheresis / Q000295:instrumentation / Q000379:methods; D008297:Male; D009447:Neuroblastoma / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D013997:Time Factors
D015703:Antigens, CD; D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor