Treatment of Relapsed and Refractory Neuroblastoma

Matthay, Katherine K.; Kushner, Brian H.

doi:10.1007/3-540-26616-x_12

Cited by 1 publication

(1 citation statement)

References 165 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In therapy-resistant NB patients, survival is not improved by HDCT/autoSCT or antibody-mediated immunotherapy, retinoids, or immune modulation with interleukin-2 [9,24]. AlloSCT might be a potential curative treatment option for these patients; however, children who have undergone tandem HDCT/autoSCT might be at very high risk of developing regimen-related co-morbidities that preclude them from receiving standard alloSCT.…”

Section: Discussionmentioning

confidence: 99%

Reduced‐intensity allogeneic stem cell transplantation for children with neuroblastoma who failed tandem autologous stem cell transplantation

Sung

Park

Chueh

et al. 2011

Pediatric Blood & Cancer

View full text Add to dashboard Cite

INTRODUCTIONHigh-dose chemotherapy and autologous stem cell transplantation (HDCT/autoSCT) has improved the outcome of high-risk neuroblastoma (NB). However, the 3-year event-free survival rates in the randomized trials by the Children's Cancer Group and the German Society of Pediatric Oncology and Hematology were 34% and 47%, respectively, which is still unsatisfactory [1,2]. Recently, a few investigators have shown that tandem HDCT/autoSCT may be a feasible approach to further improve the outcome [3][4][5][6]. Unfortunately, however, about half of patients still die from treatment failure even after tandem HDCT/autoSCT. The major cause of treatment failure is tumor relapse. Conventional chemotherapy has been ineffective in these patients, and there has been no realistic chance for cure with conventional options alone [7][8][9].In this context, allogeneic SCT (alloSCT) is being investigated as a potential curative treatment option for patients who failed HDCT/autoSCT because it offers a graft-versus-tumor (GVT) effect not seen in HDCT/autoSCT. The graft-versus-leukemia (GVL) effect is a widely accepted major component of alloSCT in leukemia [10], and there is emerging evidence for a GVT effect in solid tumors [11]. A GVT effect has been also demonstrated in patients with advanced NB who received alloSCT [12][13][14][15]. However, regimen-related mortality following standard alloSCT with an intensive conditioning regimen may be extremely high in patients who have been already heavily treated [16][17][18].In recent years, several groups of investigators have developed reduced-intensity conditioning (RIC) regimens that lead to engraftment of donor lymphoid and hematopoietic stem cells without the extra-hematopoietic toxicities of standard myeloablative conditioning, while conserving the GVL or GVT effect. This reduced regimen-related toxicity may make reduced-intensity alloSCT (RI alloSCT) especially suitable for patients at high-risk of regimen-related mortality, particularly previous tandem HDCT/ autoSCT recipients. In adults, striking GVT effects after RI alloSCT have been described in refractory breast cancer and renal cell carcinoma [19,20]. However, reports concerning the possible GVT effect of RI alloSCT remain very limited in pediatric solid tumors, particularly in NB [21]. In this context, we evaluated the feasibility and efficacy of RI alloSCT in patients with NB who failed tandem HDCT/autoSCT. PATIENTS AND METHODS PatientsFrom March 2008 to March 2009, patients with NB who failed tandem HDCT/autoSCT were eligible. Patient with grade III/IV comorbid organ dysfunction prior to RI alloSCT was excluded from the study. This prospective study was approved by Samsung Medical Center Institutional Review Board, and informed consent was obtained from all parents/guardians. Treatment Prior to RI AlloSCTConventional chemotherapy was administered in order to reduce the tumor burden as much as possible prior to transplant. A salvage chemotherapy regimen was selected according to the regimen used prior to relapse, tol...

show abstract

Section: Discussionmentioning

confidence: 99%