Intensive induction chemotherapy followed by high dose chemotherapy with autologous hematopoietic progenitor cell rescue in young children newly diagnosed with central nervous system atypical teratoid rhabdoid tumors

Abstract

Three of seven children with CNS AT/RT treated on HS II have experienced long term remissions. Long term survival can be achieved in a subset of young children with CNS AT/RT following resection with the use of multi-drug chemotherapy including high dose methotrexate and myeloablative chemotherapy without radiation therapy (RT).

Survival outcomes in atypical teratoid rhabdoid tumor for patients undergoing radiotherapy in a Surveillance, Epidemiology, and End Results analysis

“…11,14 There is also evolving evidence that dose-intensive chemotherapy and autologous hematopoietic stem cell rescue, particularly with the use of high-dose methotrexate, may be of benefit in young children with ATRT. 1,15,24,25 Despite its benefits, tumor progression during adjuvant chemotherapy, particularly locoregionally, is relatively common and is associated with decreased survival. 1,3,9,13 Thus, interest in a potential role for adjuvant RT in the prevention of local recurrence and cerebrospinal fluid dissemination has continued to grow.…”

“…Given the rarity of ATRT, large retrospective analyses are important sources of information to guide the development of treatment strategies. 1,9,10,[12][13][14][15] The objectives of the current study were to identify clinical and prognostic factors for ATRT and to determine whether the use of RT has changed in the last decade in light of information suggesting its importance in the management of ATRT using the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database. The SEER Program collects cancer survival and incidence information from population-based cancer registries that encompass approximately 28% of the US population, which provides an opportunity to study rare entities like ATRT.…”

Decreased morbidity and mortality of autologous hematopoietic transplants for children with malignant central nervous system tumors: the ‘Head Start’ trials, 1991–2009

“…[13][14][15][16][17][18][19][20][21][22] The basic treatment schema consisted of five 21-to 28-day cycles of induction chemotherapy: cisplatin (3.5 mg/kg) on day 0, vincristine (0.05 mg/kg) on days 0, 8 and 15, cyclophosphamide (65 mg/kg) on days 1 and 2 and etoposide (4 mg/kg) on days 1 and 2 (Regimen A, HS I) with the addition of high-dose methotrexate (400 mg/kg) on day 3 for metastatic patients (HS II Regimen A2), or with two cycles replacing cisplatin and methotrexate by oral etoposide (1.67 mg/kg/day) on days 1-10 and oral temozolomide (6.5 mg/kg/day) on days 1-5 (HS III Regimen D or D2). During HS III, Regimen D was modified due to toxicities by reduction of cyclophosphamide to 55 mg/kg/day and methotrexate to 320 mg/kg.…”

“…These trials sought to improve patients' cure rate and quality of survival through avoidance or reduction of CNS irradiation by utilizing a single cycle of marrow-ablative chemotherapy with autologous hematopoietic rescue as consolidation following initial induction chemotherapy. [13][14][15][16][17][18][19][20][21][22] The goal of this present study was to examine changes in the rate of serious toxicities (grades III-V) associated with AuHCR in the first 100 days following transplant over the course of the 'Head Start' trials from 1991 to 2009.…”

Myeloablative chemotherapy with autologous hematopoietic progenitor cell rescue for childhood central nervous system tumors

“…Cure even in the absence of radiotherapy has been documented in some reports. [26][27][28] Malignant gliomas Malignant gliomas are much less common in the pediatric age group than in adults; therapy is based on aggressive surgical resection whenever feasible, followed by local field irradiation and adjuvant chemotherapy. The prognosis of these tumors is extremely poor.…”