title: Double high-dose chemotherapy and stem cell transplantation in adult Wilms' tumor.
abstract: High-dose chemotherapy intensification and hematopoietic stem cell support remains a valuable treatment option for the rare patient with relapsed Wilms' tumor. We report a 22-year-old adult male with an initially diagnosed stage II Wilms' tumor, treated by nephrectomy followed by adjuvant chemotherapy. After 1 year, an intra-abdominal relapse was treated with salvage ifosfamide carboplatin etoposide chemotherapy followed by autologous hematopoietic stem cell mobilization. It was intended that he would receive two tandem cycles of high-dose chemotherapy; the first consisting of melphalan etoposide carboplatin; however, the patient did not return to receive the second cycle while in remission, but did return later with grossly relapsed disease. He was then treated with a novel preparative regimen incorporating high-dose topotecan (topotecan, melphalan and cyclophosphamide). This case confirms the feasibility of double high-dose chemotherapy with hematopoietic stem cell support in relapsed Wilms' tumor. A detailed discussion with an extensive review of the literature, regarding studies evaluating the role and indications of high-dose chemotherapy in Wilms' tumor is provided.
authors.affiliation: Second Division of Medical Oncology, Department of Medicine, 'Metaxa' Cancer Hospital, Pireaus, Greece. ckosm1@ath.forthnet.gr
authors.forename: Christos
authors.initials: C
authors.lastname: Kosmas
authors.forename: Theodoros
authors.initials: T
authors.lastname: Daladimos
authors.forename: Aggelos
authors.initials: A
authors.lastname: Athanasopoulos
authors.forename: Evangelos
authors.initials: E
authors.lastname: Theotikos
authors.forename: George
authors.initials: G
authors.lastname: Tsakonas
authors.forename: Athanasios
authors.initials: A
authors.lastname: Karabelis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Mylonakis
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D000068258:Bevacizumab; D016190:Carboplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D017239:Paclitaxel / Q000008:administration & dosage; D011859:Radiography; D016879:Salvage Therapy; D019772:Topotecan / Q000008:administration & dosage; D014182:Transplantation, Autologous; D009396:Wilms Tumor / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000972:Antineoplastic Agents, Phytogenic; D000068258:Bevacizumab; D005047:Etoposide; D019772:Topotecan; D003520:Cyclophosphamide; D016190:Carboplatin; D017239:Paclitaxel; D008558:Melphalan; D007069:Ifosfamide