Autologous stem cell transplant for high‐risk neuroblastoma: Achieving cure with low‐cost adaptations

Jain, Richa; Hans, Rekha; Totadri, Sidharth; Trehan, Amita; Sharma, Ratti Ram; Menon, Prema; Kapoor, Rakesh; Saxena, Akshay Kumar; Mittal, Bhagwant Rai; Bhatia, Prateek; Kakkar, Nandita; Srinivasan, Radhika; Rajwanshi, Arvind; Varma, Neelam; Samujh, Ram; Marwaha, Neelam; Bansal, Deepak

doi:10.1002/pbc.28273

Cited by 21 publications

(25 citation statements)

References 34 publications

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“…The burden can be decreased with innovative adaptations to treatment. 27,28 It must also be taken into account that the lack of health care resources and limited ability to care for children diagnosed with cancer contributes to work-related stress and dissatisfaction in paediatric oncology staff. 29 This survey indicated an indifference towards the management of NB when the treatment modalities were limited.…”

Section: Discussionmentioning

confidence: 99%

“…18 Building the capacity of medical staff in managing tumours is an important factor improving survival for NB patients receiving highintensity treatments. 27,28 One way this can be achieved is by decreasing treatment-related mortality by focusing on supportive care measures and nursing quality indicators. 29 This was demonstrated by the French-African Pediatric Oncology Group who treated B-cell lymphoma with LMB modified protocols in Morocco.…”

Section: Ta B L Ementioning

confidence: 99%

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Neuroblastoma: The basis for cure in limited‐resource settings

Heerden

Kruger

Esterhuizen

et al. 2021

Pediatric Blood & Cancer

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Background: Neuroblastoma (NB) contributes the most to the mortality of childhood malignancies worldwide. The disease spectrum is heterogenous and the management complex and costly, especially in advanced disease or disease with adverse biology. In low-and middle-income countries (LMICs) the majority of NB presents in advanced stages. Therefore, with limited resources and poor prognosis the treatment of NB is often not a priority. The aim of the study was to evaluate the research activities and perceptions of the management of NB that determine the research and treatment approaches in LMICs. Methods: Data were sourced from https://www.clinicaltrials.gov/ identifying NB trials open to LMIC. Abstracts on NB research presented at the International Society for Paediatric Oncology (SIOP) Congresses between 2014 and 2020 were evaluated according to income status. An online survey evaluating medical views on NB in LMICs and the effect on the management was conducted. Descriptive analysis was done. Where appropriate categorical association between covariates was assessed using the Pearson chi-square (χ 2 ) test or Fishers exact test. Results: There were 15/562 (2.7%) trials open to LMIC. Only six of 138 (4.3%) LMIC participated in NB trials. Of the 688 abstracts presented between 2014 and 2020 at the SIOP International Congress on NB as primary subject, 297 (42.7%) were from LMICs. Only two were from low-income countries (LICs). Sixty-one countries responded to the NB survey. Positive views towards NB management were present when treatment was based on a national protocol, the availability of trimodal or advanced treatment options were present, and when a balance of metastatic or local disease were treated. Conclusion: Management of NB in LMICs should include increased advocacy and research as well as implementation of national management strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Ta B L Ementioning

confidence: 99%

Neuroblastoma: The basis for cure in limited‐resource settings

Heerden

Kruger

Esterhuizen

et al. 2021

Pediatric Blood & Cancer

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“…For ASCT to be widely available to patients with HR-NB in LMIC, we incorporated several low-cost adaptations, reported earlier. 7 The strategy now enables us to offer ASCT universally to all patients with HR-NB in our center. The 3-year OS of patients with HR-NB with ASCT was 41% in our center.…”

Section: Discussionmentioning

confidence: 99%

“…Expertise and facility for high-dose chemotherapy with ASCT rescue is available in limited centers in LMIC. [6][7][8][9] Dinutuximab is not available in the majority of LMIC, including India. A diagnosis of HR-NB is grueling for the pediatric oncology team, the patient, and the family alike.…”

Section: Introductionmentioning

confidence: 99%

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Survival in patients with High-Risk Neuroblastoma without autologous stem cell transplant and dinutuximab

Jain¹,

Trehan²,

Menon³

et al. 2020

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Background: The majority of patients with high-risk neuroblastoma (HR-NB) in low-and middle-income countries (LMIC) do not have access to autologous stem cell transplant (ASCT) and dinutuximab. Consolidation with non-myeloablative chemotherapy is not well-defined, and the outcomes are variable. We report a single-center outcome of patients with HR-NB, treated with non-myeloablative consolidation. A tabulated compilation of similar reports is included. Procedure: A retrospective chart review of patients with HR-NB was performed from January 2009 till June 2016. Patients were treated on the backbone of HR-NBL1/SIOPEN protocol. Treatment included induction with rapid-COJEC, surgery, consolidation, radiotherapy to the primary tumor, and differentiation therapy with isotretinoin. Consolidation included 4 cycles of topotecan, vincristine, and doxorubicin (TVD) instead of ASCT. Infusion of vincristine and doxorubicin were modified for ease and to enable administration in daycare. Results: Over 7-½ years, 28 patients with HR-NB were treated. Two (7%) patients had therapy-related mortality. A relapse or disease progression occurred in 11 (39%) patients at a median duration of 17 months (IQR: 5, 18). Treatment abandonment was observed in 4 (14%) patients. The 4-year event-free survival was 29.3%. The median follow up of disease-free patients is 49 months (IQR: 45, 79). Patients with relapse were not treated further. Conclusions: A 4-year EFS of 29.3% was observed when 4-cycles of TVD were administered instead of ASCT in patients with HR-NB. The study and the review will aid stakeholders in LMIC for decision-making while considering the options of treatment for HR-NB if access to ACST and dinutuximab is lacking.

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Antineoplastics/granulocyte colony-stimulating factor

2020

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Autologous stem cell transplant for high‐risk neuroblastoma: Achieving cure with low‐cost adaptations

Cited by 21 publications

References 34 publications

Neuroblastoma: The basis for cure in limited‐resource settings

Neuroblastoma: The basis for cure in limited‐resource settings

Survival in patients with High-Risk Neuroblastoma without autologous stem cell transplant and dinutuximab

Antineoplastics/granulocyte colony-stimulating factor

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