Autologous Bone Marrow Transplantation - Blog Science Connections

ABMT in 65 Patients With Neuroblastoma 409
patients (quick responders) who received fewer than eight courses, and three
others (who had continuous incomplete responses after eight courses) who
received more. Intensive therapy and fractionated TBI was thus performed
within 12 months of diagnosis in all patients. Median time from diagnosis to
consolidation for the whole group was 8 months.
The next 28 patients received induction regimens of high-dose VP-16-
213 (etoposide) and cisplatin alone or in combination with ifosfamide and
actinomycin. As soon as possible after surgery, bone marrow transplantation
(BMT) was attempted with the same conditioning regimen as shown in Figure
1. For this group, median time from diagnosis to consolidation was 4
months.
Among the 65 patients eligible for consolidation during this period
(January 1983 to November 1986) 6 are still on the protocol preceding
surgery and only 59 are évaluable. Among these 59 patients, 23 were girls,
and their median age was 3 years, 8 months. Bone marrow invasion was
documented in all cases except one (a child who had bone lesions only), and
42 patients had bony involvement (two or more lesions). A retroperitoneal
primary tumor was present in 53 cases including three initial thoracic and one
jaw tumor, and two tumors of unknown origin.
At the time of intensive therapy consolidation, which always followed
surgery, and 2 months later, patients were defined as in CR, very good partial
remission (VGPR), or PR according to the following criteria:
—CR represents complete surgical excision, normal catecholamines,
normal marrow, as determined by a minimum of four assays of aspirates and
four biopsies (under general anesthesia), and a normal bone scan (or biopsyproved
negative residual lesion).
—VGPR represents a more than 90% removal of the lesion at surgery,
DAYS 1 2 3 * 5 6 7
VINCRISTINE
1.5 mg/m' IV BOLUS •
0.5 mg/m J /Day CONTINUOUS
INFUSION
TOTAL BODY IRRADIATION
6 x 2 Grays
• • •
HIGH DOSE MELPHALAN
•
180 mg/m'
BONE MARROW TRANSPLANTATION •
Figure 1. Intensive therapy regimen used by our group since January 1982.