[Megachemotherapy and autologous hematopoietic stem cell transplantation in children with solid tumours excluding neuroblastoma--experience of Polish paediatric centres].
AIM OF THE STUDY was to present the experience of four Polish transplantation centres (Wroclaw, Bydgoszcz, Kraków and Lublin) with use of megachemotherapy (MCT) and autologous hematopoietic stem cell transplantation (autoHSCT) in children with high risk solid tumours.


METHODS
Between 1994 and 2005 in 67 patients, whose age ranged form 1.5 to 20 years, 74 procedures of megachemotherapy and auto HSCT were performed. 25 children were treated for Ewing Sarcoma, 13 for rhabdomyosarcoma embryonale (RMS), 7 for germinal tumours, 6 for medulloblastoma, 4 for PNET, 4 for Wilm's tumours, 2 for glioblastoma and single patients with mesenchymoma, astrocytoma, ependymoma, angioblastoma, carcinoma ovarian and carcinoma embryonale glutei. Most common megachemotherapy protocols consisted of: Melphalan, Etopozyd i Carboplatin (MEC)--applied in 24 children and Busulfan plus Melphalan (Bu Mel) administered in 19 patients. In 29 children MCH was introduced in first complete remission, in 14 the procedure was performed in second or subsequent remission and 24 patients did not achieve remission before megachemotherapy was started.


RESULTS
30 children are alive (44%), 28 of them in complete remission of disease. 23 out of 29 (79%) patients were transplanted in first complete remission and median observation time in that group is 29 months (range 2-74 months). Only 5 out of 38 children transplanted in second complete remission or without complete remission survived. 39 patients relapsed at a median time 11 months after MCT and 37 of them subsequently died of disease at a median time of 16 months. One toxic death was noted--it was a boy, transplanted with progressive disease.


CONCLUSIONS
1. Megachemotherapy with autologous stem cell can rescue children with high risk solid tumours. It is a safe procedure especially when performed in remission. 2. Children with resistant or relapsed solid tumours are unlikely to benefit from megachemotherapy.
Drabko
Katarzyna
K
Klinika Hematologii i Onkologii Dzieciecej, ul. Chodźki 2, 20-093 Lublin, Poland.
Choma
Marta
M
Zaucha-Prazmo
Agnieszka
A
Wójcik
Beata
B
Gorczyńska
Ewa
E
Kałwak
Krzysztof
K
Turkiewicz
Dominik
D
Słociak
Małgorzata
M
Ussowicz
Marek
M
Dyla
Agnieszka
A
Chybicka
Alicja
A
Styczyński
Jan
J
Debski
Robert
R
Wysocki
Mariusz
M
Goździk
Jolanta
J
Ratajczak
Mariusz
M
Kowalczyk
Jerzy R
JR
D000046:Academic Medical Centers; D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004806:Ependymoma / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy / Q000601:surgery; D005910:Glioma / Q000188:drug therapy / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D008577:Meningeal Neoplasms / Q000188:drug therapy / Q000601:surgery; D008579:Meningioma / Q000188:drug therapy / Q000601:surgery; D009367:Neoplasm Staging; D009369:Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D016522:Oncology Service, Hospital; D011044:Poland; D012074:Remission Induction; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000601:surgery; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating