Autologous Bone Marrow Transplantation - Blog Science Connections

386 ABMT in Metastatic Neuroblastoma
RESULTS
Thirty-three patients received the first course of high-dose chemotherapy
followed by ABMT. Of these, 18 received the second course 3-4 months
later. The 15 remaining patients received only one course of the high-dose
chemotherapy. The reasons for exclusion from the second course were: early
deaths, two patients; relapse occurring before the second course, seven
patients; life-threatening toxicity during the first course excluding the patient
from the second course, five patients; and one other patient is presently
scheduled for a second course.
Survival
At present, 16 patients are alive in continuous CR, with a median followup
postdiagnosis of 28 months (range, 8-50 months). Ten patients received
two courses of high-dose chemotherapy and six received one course. The
median follow-up since the last ABMT is 15 months for the twice-grafted
patients (range, 2-38 months) and 19 months for the six remaining patients
(range, 2-30 months). Fourteen patients relapsed, seven before the second
course of high-dose chemotherapy and seven after. One of these relapses
was exclusively local, at the primary site. The remainder were distant,
involving the bone and/or bone marrow. Four complication-related deaths
occurred, two following the first course of high-dose chemotherapy and two
after the second course. The probability of the overall disease-free survival
rate at 2 years postdiagnosis is 50.5%. Taking into account the entire
population of 62 patients with stage IV neuroblastoma referred to our
institution during the same period, the overall disease-free survival rate at 2
years postdiagnosis was 27.4%; the survival rate of patients who did not
respond to primary therapy and were therefore not grafted was very poor
(7.7%). These results are summarized in Figure 1.
Various factors with a possible influence on the results were studied. The
factors were gender, age, extent of disease at diagnosis, status before highdose
chemotherapy, and response to primary therapy aimed at CR. No
prognostic factors could be found related to gender, age, extent of disease, or
status of the disease prior to high-dose chemotherapy in these patients with
stage IV disease who were more than 1 year old at diagnosis. The quality of
the response to primary chemotherapy might be of prognostic value. Of the
33 patients who received grafts, 24 received three to seven courses of CADO
(cyclophosphamide, Adriamycin [ doxorubicin ], Oncovin [vincristine]) as the
first-line conventional chemotherapy. With the use of this single combination
and surgery at the primary site, 13 patients entered CR or GPR (group I).
Eleven failed to respond to this first-line chemotherapy, and the use of a
second-line conventional chemotherapy (combination of cisplatin + VP-16-
213 [etoposide]) (11) was necessary for them to enter CR or GPR (group II).
Patients from group I responded well to conventional chemotherapy, whereas