title: Rapid-sequence tandem transplant for children with high-risk neuroblastoma.
abstract: BACKGROUND
  The majority of patients with high risk neuroblastoma (NB) still relapse.
  
  
  METHODS
  We designed a Phase II trial for children with advanced NB utilizing a program of induction chemotherapy followed by tandem high-dose chemoradiotherapy with stem cell rescue (HDC/SCR) in rapid sequence. Fifty-five patients were evaluable, ages 1-14 years, and 97 cycles of HDC/SCR have been completed to date. Pheresis was possible for every patient, despite their young age, with an average of 7.2 x 10(6) CD34+ cells/kg available to support each HDC/SCR cycle.
  
  
  RESULTS
  Engraftment was rapid, with median time to neutrophil engraftment of 11 days. Five patients who completed the first HDC course did not complete the second and there were four toxic deaths. With a median follow-up of 24 months from diagnosis, 38 of 55 patients (3-year EFS 59%) remain event-free. A subset of the patients received stem cells purged by CD34 selection. The engraftment and EFS of these patients are similar to the overall group.
  
  
  CONCLUSIONS
  This work demonstrates that a tandem transplant regimen for high-risk NB is a feasible treatment strategy in children and may improve disease-free survival.
authors: Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania 19104, USA. grupp@email.chop.edu
authors: S A
authors: SA
authors: Grupp
authors: J W
authors: JW
authors: Stern
authors: N
authors: N
authors: Bunin
authors: C
authors: C
authors: Nancarrow
authors: R
authors: R
authors: Adams
authors: J B
authors: JB
authors: Gorlin
authors: G
authors: G
authors: Griffin
authors: L
authors: L
authors: Diller
mesh_terms: D000293:Adolescent; D018952:Antigens, CD34; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D009447:Neuroblastoma / Q000628:therapy*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D018952:Antigens, CD34