title: Maintenance treatment with interferon-gamma and low-dose cyclophosphamide for pediatric high-grade glioma.
abstract: BACKGROUND
  The prognosis of high-grade glioma in children is poor.
  
  
  OBJECTIVE
  Interferon-gamma may increase the immune surveillance of glioma cells. Earlier clinical evidence had shown that low dose cyclophosphamide (CPM) increased immune response.
  
  
  METHODS
  After induction treatment with simultaneous radiation and chemotherapy, patients were treated with individually increasing interferon-gamma (IFN-gamma) doses starting from 25 microg/m2/d s.c. increasing up to a maximum of 175 microg/m2/d within 7 weeks. Cyclophosphamide was given at 300 mg/m2 i.v. every 21 days. Forty pediatric glioma patients were enrolled (median age: 8.5 year, male: n = 22). Tumor locations included cerebral cortex (n = 8), basal ganglia (n = 4), brainstem (n = 24), cerebellum (n = 3), spinal cord (n = 1). Histologies were GBM (n = 14), AA (n = 14), LGG (n = 2, diffuse intrinsic pontine glioma). There was grade IV toxicity for thrombocytopenia (10%) and leucopenia (2.5%), grade III toxicity for central nervous (2.5%) and hepatic (5%) side effects, no toxic death. The observation time of the six surviving patients was: 1.2, 1.9, 4.2, 4.4, 4.6 and 4.7 years respectively. The median overall survival (1 year) was not significantly different from a historical control group (0.8 years). The survival of pontine gliomas appeared even inferior when compared to the previous protocol (n.s.).
  
  
  CONCLUSIONS
  Maintenance treatment with IFN-gamma and low dose CPM has no sufficient beneficial effect for the treatment of high-grade glioma.
authors.affiliation: Department of Pediatrics, MD Anderson Cancer Center, Unit 87, University of Texas, 1515 Holcombe Blvd, Houston, TX 77030, USA. jwolff@mdanderson.org
authors.forename: Johannes E A
authors.initials: JE
authors.lastname: Wolff
authors.forename: Sabine
authors.initials: S
authors.lastname: Wagner
authors.forename: Christiane
authors.initials: C
authors.lastname: Reinert
authors.forename: Astrid
authors.initials: A
authors.lastname: Gnekow
authors.forename: R-D
authors.initials: RD
authors.lastname: Kortmann
authors.forename: Joachim
authors.initials: J
authors.lastname: Kühl
authors.forename: Stefaan W
authors.initials: SW
authors.lastname: Van Gool
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007371:Interferon-gamma / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007371:Interferon-gamma; D003520:Cyclophosphamide