Graft versus tumor effect in the brain of a child with recurrent metastatic medulloblastoma

Abstract

Marrow ablative chemotherapy (MAC) with autologous hematopoietic stem cell transplantation (HSCT) is limited by poor bone marrow reserve after chemotherapy and/or radiotherapy, and the extent of bone/bone marrow disease. We report a child with recurrent metastatic medulloblastoma who received an allogeneic HSCT while in relapse and subsequently achieved radiological resolution of disease and favorable marrow minimal residual disease (MRD) response. Disease recurred intra-cranially at 304 days post-HSCT. Tumor biopsy 488 days post-HSCT showed infiltration with donor lymphocytes demonstrating graft-versus-tumor (GVT) effect. The patient remained alive >2 years post-HSCT. Allogeneic HSCT may be a consideration for high-risk recurrent medulloblastoma.

Concise Review: Modulating Cancer Immunity with Hematopoietic Stem and Progenitor Cells

“…The addition of tumor-treating fields has recently yielded a median survival of 20.5 months [79]. There have been some reports of success in using autologous HSPCs for some heavily pretreated incredibly fatal pediatric solid malignancies [32,[53][54][55][56][57][58]. Although promising, these therapeutic strategies are focused on the value of high-dose chemotherapies that can successfully treat brain tumors.…”

“…For instance, high‐dose chemotherapy with autologous HSC transplant has seemed effective for triple negative breast cancer patients and is still being tested (NCT 02670109). Autologous HSC transplant is also especially effective in a subset of heavily pretreated pediatric brain tumor patients . Finlay et al advocate for chemotherapeutics that specifically have BM toxicity, including Thiotepa, Etoposide, Melphalan, and Busulfan and follow with allogeneic or autologous HSPC rescue .…”