Tandem high-dose therapy in rapid sequence for children with high-risk neuroblastoma

Stephan A. Grupp, Julie W. Stern, Nancy Bunin, Cheryl Nancarrow, Amy A. Ross, Mark Mogul, Roberta Adams, Holcombe E. Grier, Jed B. Gorlin, Robert Shamberger, Karen Marcus, Donna Neuberg, Howard J. Weinstein, Lisa Diller

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Abstract

Purpose: Advances in chemotherapy and supportive care have slowly improved survival rates for patients with high-risk neuroblastoma. The focus of many of these chemotherapeutic advances has been dose intensification. In this phase II trial involving children with advanced neuroblastoma, we used a program of induction chemotherapy followed by tandem high-dose, myeloablative treatments (high-dose therapy) with stem-cell rescue (HDT/SCR) in rapid sequence. Patients and Methods: Patients underwent induction chemotherapy during which peripheral-blood stem and progenitor cells were collected and local control measures undertaken. Patients then received tandem courses of HDT/SCR, 4 to 6 weeks apart. Thirty-nine patients (age 1 to 12 years) were assessable, and 70 cycles of HDT/SCR were completed. Results: Pheresis was possible in the case of all patients, despite their young ages, with an average of 7.2 x 106 CD34+ cells/kg available to support each cycle. Engraftment was rapid; median time to neutrophil engraftment was 11 days. Four patients who completed the first HDT course did not complete the second, and there were three deaths due to toxicity. With a median follow-up of 22 months (from diagnosis), 26 of 39 patients remained event-free. The 3-year event-free survival rate for these patients was 58%. Conclusion: A tandem HDT/SCR regimen for high-risk neuroblastoma is a feasible treatment strategy for children and may improve disease-free survival. (C) 2000 by American Society of Clinical Oncology.

Original languageEnglish (US)
Pages (from-to)2567-2575
Number of pages9
JournalJournal of Clinical Oncology
Volume18
Issue number13
DOIs
StatePublished - Jul 2000

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Grupp, S. A., Stern, J. W., Bunin, N., Nancarrow, C., Ross, A. A., Mogul, M., Adams, R., Grier, H. E., Gorlin, J. B., Shamberger, R., Marcus, K., Neuberg, D., Weinstein, H. J., & Diller, L. (2000). Tandem high-dose therapy in rapid sequence for children with high-risk neuroblastoma. Journal of Clinical Oncology, 18(13), 2567-2575. https://doi.org/10.1200/JCO.2000.18.13.2567