Tandem high-dose chemotherapy and autologous stem cell rescue in patients over 1 year of age with stage 4 neuroblastoma

초록

From June 1997 to August 2005, 52 consecutive newly diagnosed stage 4 neuroblastoma patients over 1 year of age were assigned to receive tandem high-dose chemotherapy and autologous stem cell rescue (HDCT/ASCR) as consolidation therapy. Fifty of the 52 patients underwent a first HDCT/ASCR and 44 patients underwent a second HDCT/ ASCR. Eight patients (15.4%) died from treatment-related toxicity (seven during the second HDCT/ ASCR). Total body irradiation (TBI) in the. rst HDCT/ ASCR and a shorter interval (< 12 weeks) between the first and second HDCT/ ASCR were associated with a higher rate of treatment-related death in the second HDCT/ ASCR (P = 0.032 and 0.095, respectively). The tumor relapsed or progressed in 11 patients, and 33 patients remained event free with a median follow-up of 53 months (range 19 - 117) from diagnosis. The 5-year event free survival (EFS) (+/- 95% confidence interval) for all 52 patients was 62.1 +/- 13.7%. The application of TBI and local radiotherapy, and a longer interval between the. rst and second HDCT/ ASCR were independently associated with a better EFS (P = 0.026, 0.007 and 0.020, respectively). However, further studies will be needed to decrease the toxic death rate in the second HDCT/ ASCR while reducing the relapse rate.

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