title: Efficacy of high-dose chemotherapy and autologous stem cell transplant for recurrent Wilms' tumor: a meta-analysis.
abstract: Long-term survival of relapsed Wilms' tumor patients is about 40% to 70%. Modern second-line treatment consists of either (a) salvage chemotherapy+/-radiation therapy (CT) or (b) chemotherapy followed by high-dose chemotherapy and autologous hematopoietic stem cell rescue (ASCR). Here, we conduct an individual patient data meta-analysis on 100 patients collected from 6 studies to determine characteristics that predict survival in relapsed patients who received ASCR therapy. We compare these results with survival data on 118 CT treated patients from 2 recently published studies. Four year overall survival among the combined ASCR treated patients was 54.1% (95% CI: 42.8-64.1%). The ASCR patients who only relapsed in the lungs had higher 4-years survival rates 77.7% (58.6% to 88.8%) than those who relapsed in other locations and/or suffered multiple relapses 41.6% (24.8% to 57.6%). Although lung-only relapse is considered a favorable prognostic factor, there was no clear advantage for the patients treated with salvage chemotherapy. Four-year survival rates among stage I-II patients were about 30% higher with CT than ASCR, but the 2 were comparable for stage III-IV patients. These findings suggest salvage chemotherapy is typically the better choice for relapsed Wilms' tumor patients, ASCR could be considered for stage III-IV patients with a lung-only relapse.
authors.affiliation: Department of Biostatistics, UCLA School of Public Health, Division of Hematology Oncology, Mattel Children's Hospital at UCLA, CA 90095-1752, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Presson
authors.forename: Theodore B
authors.initials: TB
authors.lastname: Moore
authors.forename: Pamela
authors.initials: P
authors.lastname: Kempert
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D016879:Salvage Therapy / Q000379:methods*; D033581:Stem Cell Transplantation; D009396:Wilms Tumor / Q000401:mortality / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents