Autologous Bone Marrow Transplantation - Blog Science Connections

398 Unpurged ABMTfor Neuroblastoma
prognosis: 11 of 20 (55%) patients with resistant disease or in relapse and 12 of
14 (8656) patients who had newly diagnosed disseminated neuroblastoma
achieved a major response. The consolidation regimen utilized in this study was
first proposed by Philip et al. (16) for patients with disseminated neuroblastoma.
Fractionated TBI was given with two chemotherapeutic agents known to be
effective in neuroblastoma: the dose-effect relationship for melphalan in
neuroblastoma and other solid tumors has been documented (5), and the
efficacy of high-dose vincristine in continuous infusion has been demonstrated
in solid tumors resistant to first-line treatment (17). The role of TBI in treating
neuroblastoma is not yet clear; however, this pediatric tumor, which is often
disseminated, is known to be radiosensitive (18).
In our group of patients the response obtained in four of five children with
measurable disease shows the additional therapeutic benefit of AT and ABMT.
However, the brief duration of remission confirms that AT and ABMT cannot be
considered the solution for patients who do not completely respond to
conventional therapy. This group is the best patient population for the use and
study of new therapeutic strategies.
The brief follow-up does not allow us to draw any conclusions about the
long-term efficacy of our program, but the fact that 11 of 20 patients are in CR
with a median follow-up of 7 months from ABMT indicates that this therapeutic
approach may improve prognosis. Ten out of 20 évaluable patients relapsed:
six in extramedullary sites, three in bone marrow, and one in both types of sites.
The role of minimal residual disease in reinfused marrow in inducing relapse is
unclear. Some groups have included purging in their study of ABMT ( 19,20). In
this study utilizing unpurged marrow, the bone marrow relapse rate is low.
Adequate supportive therapy and careful evaluation of patients during
treatment has permitted us to perform AT and ABMT in normal reverse
isolation without major complications. Despite significant infectious morbidity
and severe gastrointestinal toxicity, the mortality rate is less than 5%.
ACKNOWLEDGMENTS
This work was supported in part by the International Agency for Research
on Cancer and by CNR contract 86006544.
We thank J. T. Kemshead of London, who kindly provided the monoclonal
antibody OJ134, and we thank Silvana Berlengiero for her precious help in
typing the manuscript. We are also grateful to colleagues, all from departments
of pediatrics or pediatric oncology, who referred to our service and who
participated in the study: P. E. Comelli and R. Lamura of Civic Hospital in
Bergamo; F. Massolo and A. M. Piccinini of the University of Modena; V.
Tammaro, P. Catera, F. De Maddi, and P. Antonelli of Cardarelli Hospital in
Naples; M. T. Di Tullio, F. Casale, and P. Indolfi of the University of Naples; L.
Zanesco, M. Carli, and P. Coleselli of the University of Padua; M. Lo Curto, A.
Zincone, and M. G. Fugardi of the University of Palermo; C. Pianca and C. De