Double high-dose chemotherapy with autologous stem cell transplantation in patients with high-risk neuroblastoma: a pilot study in a single center.
Double high-dose chemotherapy (HDCT) was applied to 18 patients with highrisk neuroblastoma including 14 patients who could not achieve complete response (CR) even after the first HDCT. In 12 patients, successive double HDCT was rescued with peripheral blood stem cells collected during a single round of leukaphereses and in 6 patients, second or more rounds of leukaphereses were necessary after the first HDCT to rescue the second HDCT. The median interval between the first and second HDCT (76 days; range, 47-112) in the single harvest group was shorter than that (274.5 days; range, 83-329) in the double harvest group (p<0.01). Hematologic recovery was slow in the second HDCT. Six (33.3%) treatment-related mortalities (TRM) occurred during the second HDCT but were not related to the shorter interval. Disease-free survival rates at 2 years with a median follow-up of 24 months (range, 6-46) in the single and double harvest group were 57.1% and 33.3%, respectively. These results suggest that successive double HDCT using the single harvest approach may improve the survival of high-risk patients, especially who could not achieve CR after the first HDCT despite delayed hematologic recovery and high rate of TRM during the second HDCT.
Sung
Ki Woong
KW
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Yoo
Keon Hee
KH
Chung
Eun Hee
EH
Cho
Eun Joo
EJ
Jung
Hye-Lim
HL
Koo
Hong Hoe
HH
Lee
Suk Koo
SK
Lim
Do Hoon
DH
Kim
Dae Yong
DY
Kim
Dae Won
DW
Kim
Hyung Rok
HR
Kim
Sun Woo
SW
D000971:Antineoplastic Combined Chemotherapy Protocols; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D007937:Leukapheresis; D008297:Male; D009447:Neuroblastoma / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D010865:Pilot Projects; D012074:Remission Induction; D012307:Risk Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome