Successive double high-dose chemotherapy with peripheral blood stem cell rescue collected during a single leukapheresis round in patients with high-risk pediatric solid tumors: a pilot study in a single center

Abstract

Summary:In total, 18 of 26 double high-dose chemotherapies (HDCT) in pediatric solid tumors were rescued with peripheral blood stem cells collected during a single leukapheresis round (single-harvest group, SHG). In the remaining eight HDCT, additional leukapheresis were necessary after the first HDCT (HDCT1) to rescue the second HDCT (HDCT2) (double-harvest group, DHG). Stem cell collection after HDCT1 was inefficient and delayed in patients who had received prior chemotherapy before HDCT1. The interval between HDCT1 and HDCT2 was shorter in SHG than in DHG (median 62.5 days vs 178.5 days, P-value ¼ 0.002). Hematologic recovery in HDCT2 was delayed compared to HDCT1. However, there was no difference in hematologic recovery between SHG and DHG. A high rate of treatment-related mortality (TRM) was recorded during HDCT2, but there was no evidence that the shorter interval caused a higher rate of TRM (P-value ¼ 0.454). The probability of disease-free survival at 2 years after HDCT2 in the SHG and DHG were 66.7 and 25.0%, respectively (Pvalue ¼ 0.031). Therefore, to administer the second HDCT earlier in double HDCT, and thus to improve the survival of patients with high-risk solid tumors, the single-harvest approach is recommended rather than the double-harvest approach.

The impact of recent vincristine on human hematopoietic progenitor cell collection in pediatric patients with central nervous system tumors

“…Heavy pretreatment and radiation have both been linked to decreased CD34 yields in children . To our knowledge, this is the first report showing an adverse impact by MC‐VCR on CD34 collection, despite its widespread use in pediatric malignancies .…”

“…To further improve outcomes in infants and other high‐risk patients, more recent studies have added high‐dose, myeloablative chemotherapy and autologous stem cell rescue . Patients generally undergo autologous peripheral blood human progenitor cell collection (AHPCC) after their first or second cycle of induction chemotherapy, followed later by one to three cycles of high‐dose chemotherapy and stem cell rescue . Because VCR is considered “marrow sparing” at the doses used clinically, most protocols stipulate the continued administration of weekly VCR between induction chemotherapy cycles (midcycle VCR [MC‐VCR]), regardless of scheduled AHPCC .…”

High‐dose chemotherapy and autologous stem cell rescue in children with newly diagnosed high‐risk or relapsed medulloblastoma or supratentorial primitive neuroectodermal tumor

“…The dose intensities during the second HDCT were slightly lower than those employed in previous studies where CTE or BM was used as single HDCT regimen 12,13. In our study, because of the fear of a possible higher TRM rate during second HDCT 25, we reduced the intensity of second HDCT regimen. The optimal combination of regimens for the consecutive double HDCT has yet to be determined.…”

“…The remaining two patients underwent collection of bone marrow stem cells. As previously described 25, when tandem double HDCT and ASCR were planned, we tried to collect at least 5 × 10 6 CD34 + cells/kg in order to rescue patients receiving double HDCT with peripheral blood stem cells (PBSCs) collected during a single leukapheresis round.…”

Retrospective Analysis of Peripheral Blood Stem Cell Transplantation for the Treatment of High-Risk Neuroblastoma

“…These investigators demonstrated that PBSC-supported tandem transplantation in high-risk NBL is feasible with acceptable toxicity and adequate hematopoietic recovery. Subsequently, several investigators found that PBSC-supported double/triple tandem cycles of high-dose chemotherapy achieved higher EFS than single transplantation (4, 25, 26). Nevertheless, 3- and 5-yr EFSs were still below 60%.…”