title: Comparison of toxicity following different conditioning regimens (busulfan/melphalan and carboplatin/etoposide/melphalan) for advanced stage neuroblastoma: Experience of two transplant centers.
abstract: The outcome for advanced neuroblastoma has improved with combined modality therapy: induction chemotherapy, surgery, and consolidation with high-dose chemotherapy/autologous HSCT, followed by local radiation, cisretinoic acid, and recently antibody therapy. In the United States, the most common conditioning regimen is CEM, while in Europe/Middle East, Bu/Mel has been widely used; it remains unclear which regimen has the best outcome. Assess renal, hepatic, and infectious toxicity through Day+100 in 2 different regimens. Retrospective comparison between CEM-DFCHCC Boston and Bu/Mel- CCHE-57357. Thirty-five patients, median age 4, in Boston (2007-2011) and 38 patients, median age 3, in Cairo (2009-2011). Renal toxicity; creatinine was significantly higher in CEM than Bu/Mel: 57% (median day+90) vs. 29% (median>day+100), p = 0.004. One CEM patient died from renal dialysis at day+19. Hepatic toxicity was significantly higher in CEM than Bu/Mel: 80% (median day+26) vs. 58% (median day+60), p = 0.04. In infectious complications with CEM 14%, bacteremia (n = 4) and fungemia (n = 1), 3 had culture-negative sepsis requiring vasopressors. With Bu/Mel 18%, bacteremia (n = 7), none required pressors, p = 0.4. Bu/Mel was associated with less acute hepatic and renal toxicity and thus may be preferable for preserving organ functions.
authors.affiliation: Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.|Pediatric Stem Cell Transplantation Unit, Dana Farber/Children's Hospital Cancer Care Center, Boston, MA, USA.|Pediatric Hematology/Oncology and Stem Cell Transplant Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.|Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.
authors.forename: Yasser
authors.identifier: http://orcid.org/0000-0002-5528-0025
authors.initials: Y
authors.lastname: Elborai
authors.affiliation: Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.|Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.
authors.forename: Hanafy
authors.initials: H
authors.lastname: Hafez
authors.affiliation: Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.
authors.forename: Emad A
authors.initials: EA
authors.lastname: Moussa
authors.affiliation: Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.|Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Hammad
authors.affiliation: Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.|Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.
authors.forename: Hany
authors.initials: H
authors.lastname: Hussein
authors.affiliation: Pediatric Stem Cell Transplantation Unit, Dana Farber/Children's Hospital Cancer Care Center, Boston, MA, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Lehmann
authors.affiliation: Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.|Pediatric Oncology and Bone Marrow Transplant Department, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Elhaddad
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001900:Boston; D001932:Brain Neoplasms / Q000188:drug therapy / Q000628:therapy*; D002066:Busulfan / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004534:Egypt; D005047:Etoposide / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008558:Melphalan / Q000008:administration & dosage*; D009447:Neuroblastoma / Q000188:drug therapy / Q000628:therapy*; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D005047:Etoposide; D016190:Carboplatin; D002066:Busulfan; D008558:Melphalan
keywords: autologous hematopoietic stem cell transplantation (HSCT); busulfan/melphalan (Bu/Mel); carboplatin; etoposide; melphalan (CEM); neuroblastoma; renal toxicity