title: Myeloablative chemotherapy with autologous bone marrow rescue in children and adolescents with recurrent malignant astrocytoma: outcome compared with conventional chemotherapy: a report from the Children's Oncology Group.
abstract: OBJECTIVE
  Children and adolescents with malignant astrocytomas recurring after initial treatment have a dismal prognosis, with only rare patients surviving 1-year beyond recurrence. The purpose of this study was to attempt to improve their survival.
  
  
  METHODS
  Twenty-seven children and adolescents with malignant astrocytomas [17 glioblastoma multiforme and 10 anaplastic astrocytoma (AA)] following initial tumor progression, received myeloablative chemotherapy followed by autologous marrow rescue with one of three thiotepa and etoposide-based chemotherapy regimens, administered alone (n = 11) or combined with carmustine (n = 5) or carboplatin (n = 11). Time to progression and death following myeloablative chemotherapy for these patients was compared non-randomly with outcome of a contemporaneously treated cohort of similar patients who received only conventional chemotherapy following initial tumor progression. The two cohorts were compared for age, histology, prior therapies, extent of surgical resection at progression, and time from initial diagnosis to progression.
  
  
  RESULTS
  Five of 27 children (two with glioblastoma multiforme and three with AA) survive event-free from 8.3 to 13.3 years (median of 11.1 years) following myeloablative chemotherapy. Of 56 children with recurrent malignant astrocytoma who received conventional chemotherapy following initial progression, no patient survives. Differences in distributions of survival were not significant when stratified by surgical debulking (P = 0.39). However, for patients who were surgically debulked, the survival distributions are significantly different (P = 0.017).
  
  
  CONCLUSIONS
  Myeloablative chemotherapy with autologous marrow rescue can produce durable remissions in children and young adults with recurrent malignant gliomas, in the setting of minimal residual tumor burden achieved surgically.
authors.affiliation: The Children's Center for Cancer & Blood Diseases, Department of Pediatrics, Children's Hospital, Los Angeles, California 90027, USA. jfinlay@chla.usc.edu
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Finlay
authors.forename: Girish
authors.initials: G
authors.lastname: Dhall
authors.forename: James M
authors.initials: JM
authors.lastname: Boyett
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Dunkel
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Gardner
authors.forename: Stewart
authors.initials: S
authors.lastname: Goldman
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Yates
authors.forename: Marc K
authors.initials: MK
authors.lastname: Rosenblum
authors.forename: Philip
authors.initials: P
authors.lastname: Stanley
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zimmerman
authors.forename: Dana
authors.initials: D
authors.lastname: Wallace
authors.forename: Ian F
authors.initials: IF
authors.lastname: Pollack
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Packer
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001254:Astrocytoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016026:Bone Marrow Transplantation; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016190:Carboplatin / Q000008:administration & dosage; D002330:Carmustine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D018450:Disease Progression; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019653:Myeloablative Agonists; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy*; D011379:Prognosis; D016879:Salvage Therapy; D013852:Thiotepa / Q000008:administration & dosage; D014182:Transplantation, Autologous
chemical_list: D019653:Myeloablative Agonists; D005047:Etoposide; D013852:Thiotepa; D016190:Carboplatin; D002330:Carmustine