High-dose chemotherapy and stem cell rescue for high-risk Ewing’s family of tumors

2011 ◽  
Vol 11 (2) ◽  
pp. 251-262 ◽  
Author(s):  
Joseph Rosenthal ◽  
Anna B Pawlowska
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Stem Cell Rescue ◽  
Ewing's Family Of Tumors

scholarly journals Acute Complications After High-Dose Chemotherapy and Stem-Cell Rescue in Pediatric Patients With High-Risk Neuroblastoma Treated in Countries With Different Resources

2018 ◽  
pp. 1-12 ◽  
Author(s):  
Mahmoud M. Elzembely ◽  
Julie R. Park ◽  
Khaled F. Riad ◽  
Heba A. Sayed ◽  
Navin Pinto ◽  
...  
Keyword(s):  
United States ◽  
Stem Cell ◽  
High Risk ◽  
The United States ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Stem Cell Rescue ◽  
Resource Limited ◽  
Comparative Review ◽  
Hepatitis Infection

Purpose High-dose chemotherapy with autologous stem-cell rescue (SCR) is a key component of high-risk neuroblastoma (HRNB) therapy. Carboplatin, etoposide, and melphalan (CEM) or busulfan and melphalan (Bu/Mel) are the most evaluated, effective high-dose chemotherapy for HRNB on the basis of results from major cooperative group studies. Toxicity profiles vary between these regimens, and practice variation exists regarding the preferred high-dose therapy (HDT). We sought to evaluate the safety of HDT and autologous SCR for HRNB in a resource-limited country (Egypt) compared with the resource-rich United States. Patients and Methods We performed a retrospective comparative review of single CEM-based HDT/SCR outcomes through day 100 for HRNB at the Fred Hutchinson Cancer Research Center (FH) in the United States (2005 to 2015) versus Bu/Mel-based HDT at El-Sheikh Zayed Specialized Hospital (SZ) in Egypt (2009 to 2015). Results Forty-four patients at FH and 77 patients at SZ were reviewed. Pretransplant hepatic comorbidities were significantly higher at SZ (29 of 77 v nine of 44; P = .05), with 19 of 77 patients at SZ having hepatitis infection. Engraftment was delayed after SZ-Bu/Mel therapy compared with FH-CEM therapy for neutrophils (median 12 days v 10 days, respectively; P < .001) and platelets (median 20 days v 18 days, respectively; P < .001). Sinusoidal obstruction syndrome occurred later, after SZ-Bu/Mel therapy (median 19 days v 7 days; P = .033), and four of eight cases were fatal (six of eight patients had underlying hepatitis infection), whereas three of three cases after FH-CEM therapy were moderately severe. Resource utilization associated with the number of days with fever, antibiotic use, and the number of transfusions administered was significantly higher after FH-CEM therapy than after SZ-Bu/Mel therapy. Conclusion Use of autologous stem-cell transplantation is feasible in the context of a resource-limited country.

High-Dose Chemotherapy and Autologous Stem Cell Transplantation In Patients With High-Risk Neuroblastoma : Results Of Turkish Pediatric Oncology Group- Neuroblastoma 2003 (TPOG-NBL 2003) Protocol

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3411-3411 ◽  
Author(s):  
Serap Aksoylar ◽  
Ali Varan ◽  
Canan Vergin ◽  
Volkan Hazar ◽  
Ferhan Akici ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Induction Chemotherapy ◽  
Conflicts Of Interest ◽  
Survival Rates ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Intention To Treat ◽  
Stem Cell Rescue ◽  
Chemotherapy Patients

Abstract Introduction TPOG-NBL 2003 national protocol was designed to improve treatment results of the high risk patients by adjunction of stem cell rescue with intensive multimodal therapy. Material and Methods High risk stratification was made according to COG criteria. Just before the third cycle of chemotherapy, patients without progression were allocated into two treatment groups non-randomly by physicians’ and/or parent’s choices guided to the center’s facility, toxicity and social-economical facility to attain the megatherapy. After an induction of 6 chemotherapy cycles, the protocol was divided into two arms which were designed to continue the intensive conventional chemotherapy (CCT), or initiate myeloablative therapy with autologous stem-cell rescue (ASCR). All patients were also given 13-cis-retinoic acid as maintenance therapy. Results Fifty-six percent (272 patients) of all neuroblastoma patients was evaluated as high risk. Response rate to induction chemotherapy was 81% (CR/VGPR: 32%, PR: 49%) in patients at the end of induction chemotherapy. Overall EFS and OS at 3-years were 36% and 45%, respectively. Intention-to-treat analysis documented post-induction (after the six cycles of induction chemotherapy) EFS of 46% in CCT arm (137 patients) and 37% in ASCR group (55 patients) (p= 0.037); whereas, OS was 59% and 43%, respectively (p=0.052). Thirty-one patients (11%) died of treatment-related complications. Conclusion Survival rates of high-risk neuroblastoma have improved over the last decade in Turkey. The main problems when managing these patients were an effective local control, early progression and death. Megatherapy has not augmented the therapeutic end point in our country’s circumstances. However; the better the supportive care and the higher the patients’ compliance is attained, the higher the survival rates might be obtained in Turkish neuroblastoma patients. Disclosures: No relevant conflicts of interest to declare.

The role of autologous stem-cell transplantation in high-risk neuroblastoma consolidated by anti-GD2 immunotherapy: Results of 2 consecutive studies in a single referral institution.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10539-10539
Author(s):  
Jaume Mora ◽  
Alicia Castañeda ◽  
Miguel Angel Flores ◽  
Vicente Santa-María ◽  
Moira Garraus ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Cooperative Groups ◽  
Gm Csf ◽  
Stem Cell Rescue ◽  
Single Center Study ◽  
Study Population

10539 Background: Treatment of high-risk NB within the major international cooperative groups (COG and SIOP) comprise intensive induction, consolidation with high dose chemotherapy and autologous stem cell rescue (ASCR) followed by anti-GD2 immunotherapy and isotretinoin as maintenance therapy. In the COG studies dinutuximab and cytokines (GM-CSF and IL-2) were used to treat patients in complete remission (CR) after ASCR whereas SIOPEN studies used dinutuximab-beta plus/minus IL-2 and included patients with responsive (no progression 109 days after ASCR) but refractory (skeletal metaiodobenzylguanidine positivity with three or fewer areas of abnormal uptake). Methods: Since December 2014, HR-NB patients referred to HSJD were eligible for consolidation with anti-GD2/GM-CSF immunotherapy in 2 consecutive studies (dinutuximab for EudraCT 2013-004864-69 and naxitamab for 017-001829-40) and naxitamab/GM-CSF compassionate use (CU) with or without prior ASCR. Patients were enrolled in 1st CR or with primary refractory bone/bone marrow (B/BM) disease. We accrued a study population of two groups whose consolidative therapy, aside from ASCR, was similar: anti-GD2 (dinutuximab or naxitamab) antibodies + GM-CSF and local radiotherapy. This is a retrospective analysis of their event-free survival (EFS) and overall survival (OS) calculated from study entry. Results: From Dec 14 til Dec 19, 67 study patients were treated with the COG (dinutuximab + GM-CSF+ IL-2 + RA) regimen (n = 21) in the HSJD-HRNB-Ch14.18 study or with Naxitamab and GM-CSF in the Ymabs study 201 (n = 12) or CU (n = 34). 23 patients were treated with primary refractory disease in the B/BM, and 44 in 1st CR. The 67 study patients included 13 (19%) treated following single ASCR and 54 following induction chemotherapy and surgery. Median follow-up for all surviving patients is 16.2 months. Two-year rates for ASCR and non-ASCR patients were, respectively: EFS 64% vs. 54% (p = 0.28), and OS 66.7% vs. 84% (p = 0.8). For the 44 pts in 1st CR, 2-year rates for ASCR and non-ASCR patients were, respectively: EFS 65% vs. 58% (p = 0.48), and OS 71% vs. 85% (p = 0.63). Conclusions: In this retrospective, single center study, ASCR did not provide survival benefit when anti-GD2 + GM-CSF based immunotherapy was used for consolidation after dose-intensive conventional chemotherapy.

scholarly journals Secondary malignant neoplasms after high-dose chemotherapy and autologous stem cell rescue for high-risk neuroblastoma

2014 ◽  
Vol 61 (8) ◽  
pp. 1350-1356 ◽  
Author(s):  
Alissa Martin ◽  
Jennifer Schneiderman ◽  
Irene B. Helenowski ◽  
Elaine Morgan ◽  
Kimberley Dilley ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
High Dose Chemotherapy ◽  
Malignant Neoplasms ◽  
High Dose ◽  
Stem Cell Rescue ◽  
Autologous Stem Cell Rescue
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