scholarly journals Promising survival rate but high incidence of treatment‐related mortality after reduced‐dose craniospinal radiotherapy and tandem high‐dose chemotherapy in patients with high‐risk medulloblastoma

2020 ◽  
Vol 9 (16) ◽  
pp. 5807-5818
Author(s):  
Ji Won Lee ◽  
Do Hoon Lim ◽  
Ki Woong Sung ◽  
Hee Won Cho ◽  
Hee Young Ju ◽  
...  
Keyword(s):  
Survival Rate ◽  
High Risk ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Reduced Dose ◽  
Craniospinal Radiotherapy ◽  
High Incidence ◽  
Treatment Related Mortality ◽  
Related Mortality

scholarly journals MBCL-28. LONG-TERM FOLLOW-UP RESULTS OF REDUCED DOSE CRANIOSPINAL RADIOTHERAPY AND TANDEM HIGH-DOSE CHEMOTHERAPY IN PATIENTS WITH HIGH-RISK MEDULLOBLASTOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii394-iii394
Author(s):  
Ji Won Lee ◽  
Do Hoon Lim ◽  
Meong Hi Son ◽  
Ki Woong Sung ◽  
Hee Won Cho ◽  
...  
Keyword(s):  
High Risk ◽  
Cumulative Incidence ◽  
Residual Tumor ◽  
Large Cell ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Progression Rate ◽  
Reduced Dose ◽  
Craniospinal Radiotherapy

Abstract BACKGROUND In this study, we report the follow-up results of reduced-dose of craniospinal radiotherapy (CSRT) followed by tandem high-dose chemotherapy (HDCT) in patients with high-risk medulloblastoma (MB). METHODS Newly diagnosed high-risk MB patients (metastatic disease, postoperative residual tumor > 1.5 cm2 or large cell/anaplastic histology) over 3 years of age were enrolled in this study. Two cycles of pre-RT chemotherapy, RT including reduced-dose CSRT (23.4 or 30.6 Gy), 4 cycles of post-RT chemotherapy and tandem HDCT were given. NanoString and DNA sequencing were done with archival tissues. RESULTS Forty patients were enrolled, and molecular subgrouping was possible in 21 patients (2 WNT, 3 SHH, 8 Group 3 and 8 group 4). All patients including two patients who experienced progression during the induction chemotherapy underwent HDCT. Relapse/progression occurred only in four patients (10-year cumulative incidence 10.4 ± 0.3%). However, six patients died from treatment-related mortality (TRM) (4 acute TRMs and 2 late TRMs) resulting in 18.5 ± 0.5% of 10-year cumulative incidence. Taken together, the 10-year event-free survival and overall survival were 71.1 ± 8.0% and 68.9 ± 8.5%, respectively. Late effects were evaluated in 25 patients and high-tone hearing loss, endocrine dysfunction, dyslipidemia, and growth retardation were common. CONCLUSIONS Strategy using tandem HDCT following reduced-dose CSRT showed promising results in terms of low relapse/progression rate, however, the high TRM rate indicates that modification of HDCT regimen and careful selection of patients who can have benefit from HDCT will be needed in the future study.

scholarly journals Intensive Care Outcomes of Patients after High Dose Chemotherapy and Subsequent Autologous Stem Cell Transplantation: A Retrospective, Single Centre Analysis

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1678
Author(s):  
Panagiotis Karagiannis ◽  
Lena Sänger ◽  
Winfried Alsdorf ◽  
Katja Weisel ◽  
Walter Fiedler ◽  
...  
Keyword(s):  
Stem Cell ◽  
Intensive Care ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Icu Admission ◽  
One Year ◽  
Treatment Related Mortality ◽  
Related Mortality

High dose chemotherapy (HDT) followed by autologous peripheral blood stem cell transplantation (ASCT) is standard of care including a curative treatment option for several cancers. While much is known about the management of patients with allogenic SCT at the intensive care unit (ICU), data regarding incidence, clinical impact, and outcome of critical illness following ASCT are less reported. This study included 256 patients with different cancer entities. Median age was 56 years (interquartile ranges (IQR): 45–64), and 67% were male. One-year survival was 89%; 15 patients (6%) required treatment at the ICU following HDT. The main reason for ICU admission was septic shock (80%) with the predominant focus being the respiratory tract (53%). Three patients died, twelve recovered, and six (40%) were alive at one-year, resulting in an immediate treatment-related mortality of 1.2%. Independent risk factors for ICU admission were age (odds ratio (OR) 1.05; 95% confidence interval (CI) 1.00–1.09; p = 0.043), duration of aplasia (OR: 1.37; CI: 1.07–1.75; p = 0.013), and Charlson comorbidity score (OR: 1.64; CI: 1.20–2.23; p = 0.002). HDT followed by ASCT performed at an experienced centre is generally associated with a low risk for treatment related mortality. ICU treatment is warranted mainly due to infectious complications and has a strong positive impact on intermediate-term survival.

Salvage chemotherapy with high-dose carboplatin and etoposide (HDCE) with peripheral blood stem cell transplant (PBSCT) in patients with relapsed seminoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5054-5054
Author(s):  
S. M. Herbert ◽  
R. Abonour ◽  
L. H. Einhorn M.D.
Keyword(s):  
High Dose Chemotherapy ◽  
Salvage Chemotherapy ◽  
High Dose ◽  
Cell Transplant ◽  
Line Therapy ◽  
Visceral Metastases ◽  
Pure Seminoma ◽  
Third Line ◽  
Treatment Related Mortality ◽  
Related Mortality

5054 Background: Patients with relapsed seminoma are treated with salvage chemotherapy. Current therapeutic options include cisplatin plus ifosfamide based regimens or high dose chemotherapy with PBSCT. At Indiana University HDCE was usually reserved for third line therapy for relapsed seminoma, unless there were visceral metastases or relapse within 3 months of initial chemotherapy. Methods: Retrospective review of 35 consecutive patients with pure seminoma (median 38 yrs; range 23–56 yrs) that received HDCE with PBSCT from 2/96–12/04. Cytoreductive chemotherapy with 0–2 courses of vinblastine, ifosfamide, and cisplatin (VeIP) preceeded HDCE. Carboplatin dosage was 700mg/m2 for 3 days plus etoposide 750mg/m2 for 3 days. A second course of therapy was given after hematopoietic recovery. Results: Treatment related mortality was seen only in patients that received two or more prior regimens (median age 45 yrs, range 27–56 yrs) and occurred in 4/35 (11%) patients. One man died of AML at 62 months (see table below). 26/35 (74%) are continuously NED (cNED). 15/35 patients received 1 prior regimen and 14/15 (93%) are cNED. 20/35 patients received =2 prior regimens and 12/20 (60%) are NED. 14/35 patients had prior XRT. 10/14 (71%) are cNED. 6/14 patients had prior XRT and =2 prior regimens and 3/6 (50%) are NED. Conclusions: HDCE with PBSCT has a high cure rate even when used as 3rd line or later therapy. Because of the 93% continuous NED rate when used as 2nd line therapy and the increased treatment related mortality when used as 3rd line therapy we now recommend HDCE as initial salvage therapy. [Table: see text] No significant financial relationships to disclose.

High Complete Remission (CR) Rates and Reduced Early Mortality with High Dose Ara-c (HiDAC) and Mitoxantrone (MITO) Induction Chemotherapy for Older (age>60) High Risk Patients with Acute Myeloid Leukemia (AML)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3290-3290
Author(s):  
Muthalagu Ramanathan ◽  
Zheng Zhou ◽  
Jan Cerny ◽  
Glen D Raffel ◽  
Laura Petrillo-Deluca ◽  
...  
Keyword(s):  
High Risk ◽  
Median Time ◽  
Induction Chemotherapy ◽  
Cardiac Toxicity ◽  
Remission Induction ◽  
High Dose ◽  
Induction Regimen ◽  
Treatment Related Mortality ◽  
Related Mortality

Abstract Abstract 3290 Background: Patients with high risk AML, defined as those with age > 60 years or multiple medical co-morbidities determined by Charleston comorbidity index (CCI) carry a poor prognosis and inferior outcomes after 7+3 induction chemotherapy. CR rates tend to range from 6–51% and induction death rates between 9–48%. We present here a single institution experience of high risk AML patients treated with an induction regimen consisting of high dose mitoxantrone and cytarabine (HiDAC/MITO). Methods: We performed a retrospective analysis of all patients with AML who received HiDAC/MITO induction from January 2009- January 2010 at our institution. Patients with age ≥60 or age <60 with high CCI received HiDAC at 3gm/m2 over three hours on days 1 to 5 plus MITO 80mg/m2 once on day 2. Effect of other high risk features including poor risk cytogenetics, therapy related AML (t-AML), AML with prior antecedent hematological disorder (AHD) and relapsed AML on treatment outcome were also evaluated. The primary endpoints of the study were CR (defined as bone marrow blasts <5%) at day 30 and treatment related mortality within 30 days of initiation of treatment. End of follow-up was June 30, 2010. Results: 20 AML had received HiDAC/MITO for remission induction. The median age was 66.5 years (range 47 to 78), those with age ≥ 70 was 8 (40%). CCI was ≥ 5 in 18 (90%) patients. Other high risk features included high risk cytogenetics in 8 (40%) and non-denovo AML (AML with AHD, t-AML or relapsed AML) in 11 (55%). Overall CR rate was 17 (85%, CI: 61%-96%) and 3 (15%) patients had refractory disease. There was no treatment related mortality. Median time to neutrophil recovery (>1000/ul) was 27 (range 19 to 37) days and median time to platelet recovery (>100,000/ul) was 28 days (range 23 to 44) days. Patients with non–denovo AML were more likely to be refractory to treatment or relapse after day 30. Median follow up of the entire cohort is 288 (range 29 to 530) days. 3 month and 6 month overall survival (OS) was 94.7% and 73.3% and progression free survival (PFS) 93.8% and 87.5%, respectively. The median OS was 410 days (CI: 243-*); (denovo 410 vs. others 381 days). Median PFS is 524 days (CI: 381-*); (denovo *not reached vs. others 381 days). 11(55%) patients were able to proceed to autologous (4) or allogeneic (7) stem cell transplantation (SCT) after receiving HiDAC/MITO. The time to transplant ranged from 44 to 195 days. Median OS of the patients who underwent SCT is 524 days versus 269 days for the non transplant group (p =0.0038). The HiDAC/MITO induction regimen was well tolerated. Cardiac toxicity defined by symptomatic CHF was noted in 6/20 patients. Of the six patients 2 had prior cardiac history and 1 had prior anthracycline exposure and 1 had both anthracycline exposure and cardiac history. Cardiac toxicity was delayed and identified by echo at a median of 90 range (42 to139) days after induction chemotherapy. None of these patients died from cardiac toxicity. Conclusions: In this high risk AML population, HiDAC/MITO induction was well tolerated and demonstrated an overall response rate of 85% and no induction deaths, allowing a substantial number (55%) of patients to proceed to SCT. Contrary to our expectations advanced age or multiple medical co-morbidities did not affect CR rate or survival, thus high lighting the utility of this regimen for high risk newly diagnosed elderly patients with AML. Disclosures: No relevant conflicts of interest to declare.

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