Abstract
From January 2004 to December 2008, 50 consecutive patients with high-risk neuroblastoma were assigned to receive tandem HDCT (high-dose chemotherapy)/auto-SCT after nine cycles of induction chemotherapy. CEC (carboplatin + etoposide + cyclophosphamide) regimen and TM (thiotepa + melphalan)-TBI regimen (or TM regimen for stage 3 patients) were the first and second HDCT regimens. Local radiotherapy, differentiation therapy with 13-cis-retinoid acid and immunotherapy with interleukin-2 were given after tandem HDCT/auto-SCT. Of the 50 patients, 49 underwent a first HDCT/auto-SCT and 47 underwent a second HDCT/auto-SCT. The tumor relapsed or progressed in 14 patients, secondary malignancy developed in one patient and one patient died from chronic lung disease. Therefore, 34 patients remained event free with a median follow-up of 54.5 months (range, 14-94 months) from diagnosis. The probabilities of 5-year OS and EFS for all 50 patients were 77.0% (95% confidence interval (CI), 63.7-90.3) and 71.4% (95% CI, 58.7-84.1), respectively. However, all patients who remained event free for >3 years after tandem HDCT/auto-SCT experienced late adverse effects. Chemotherapeutic dose-escalation strategy using tandem HDCT/auto-SCT was very encouraging for survival. However, further studies incorporating newer treatment modalities are needed to reduce late adverse effects without jeopardizing the survival rate.
MeSH terms
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Antineoplastic Agents / administration & dosage
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Antineoplastic Agents / adverse effects
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Antineoplastic Agents / therapeutic use
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Antineoplastic Combined Chemotherapy Protocols / administration & dosage
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Antineoplastic Combined Chemotherapy Protocols / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
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Bone Neoplasms / diagnosis
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Bone Neoplasms / pathology
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Bone Neoplasms / secondary
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Bone Neoplasms / therapy
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Child
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Child, Preschool
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Combined Modality Therapy / adverse effects
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DNA Copy Number Variations
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Feasibility Studies
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Humans
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Induction Chemotherapy* / adverse effects
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Infant
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Interleukin-2 / administration & dosage
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Interleukin-2 / adverse effects
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Interleukin-2 / therapeutic use
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Isotretinoin / administration & dosage
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Isotretinoin / adverse effects
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Isotretinoin / therapeutic use
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N-Myc Proto-Oncogene Protein
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Neoplasm Proteins / genetics
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Neoplasm Proteins / metabolism
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Neoplasm Staging
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Neuroblastoma / diagnosis
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Neuroblastoma / pathology
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Neuroblastoma / secondary
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Neuroblastoma / therapy*
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Nuclear Proteins / genetics
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Nuclear Proteins / metabolism
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Oncogene Proteins / genetics
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Oncogene Proteins / metabolism
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Prognosis
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Prospective Studies
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Radiotherapy / adverse effects
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Radiotherapy / methods*
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Stem Cell Transplantation* / adverse effects
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Survival Analysis
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Transplantation, Autologous
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Whole-Body Irradiation / adverse effects
Substances
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Antineoplastic Agents
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IL2 protein, human
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Interleukin-2
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MYCN protein, human
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N-Myc Proto-Oncogene Protein
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Neoplasm Proteins
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Nuclear Proteins
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Oncogene Proteins
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Isotretinoin