title: Double high-dose chemotherapy with autologous stem cell transplantation in patients with high-risk neuroblastoma: a pilot study in a single center.
abstract: 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.
authors.affiliation: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Ki Woong
authors.initials: KW
authors.lastname: Sung
authors.forename: Keon Hee
authors.initials: KH
authors.lastname: Yoo
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Chung
authors.forename: Eun Joo
authors.initials: EJ
authors.lastname: Cho
authors.forename: Hye-Lim
authors.initials: HL
authors.lastname: Jung
authors.forename: Hong Hoe
authors.initials: HH
authors.lastname: Koo
authors.forename: Suk Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Lim
authors.forename: Dae Yong
authors.initials: DY
authors.lastname: Kim
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Kim
authors.forename: Hyung Rok
authors.initials: HR
authors.lastname: Kim
authors.forename: Sun Woo
authors.initials: SW
authors.lastname: Kim
mesh_terms: 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