Autologous Bone Marrow Transplantation - Blog Science Connections

420 ABMT in Neuroblastoma
Group 2—Four patients included in the LMCE study who did not receive
ABMT (two suffered drug-related early deaths, one died during surgery, and
one patient's parents refused ABMT).
Group 3—Ten patients referred from outside, including 3 patients who
were either in complete remission (CR, i.e., complete surgical excision,
normal catecholamines, normal marrow as tested by at least four aspirates
and four biopsies under general anesthesia, and a normal bone scan or
biopsied negative residual lesion) or very good partial remission (VGPR, i.e.,
more than 90% surgical removal, normal catecholamines, normal bone
marrow by the same criteria as for CR, and improved bone scan but without
evidence from biopsy). Seven patients were in partial remission (PR) (50% or
greater improvement of at least two of the criteria concerning initial tumor,
catecholamines, marrow, bones, with no progression at any site). The 10
patients had received various treatments and were therefore excluded from
the LMCE study but were included in a protocol of single (5 patients) or
double (5 patients) massive therapy with ABMT.
Our goal was to learn whether inclusion of these different groups in the
final evaluation of the unselected patients would change our conclusions
concerning neuroblastomas with poor prognosis.
PATIENTS AND METHODS
In group 1, all patients were classified as having stage IV neuroblastoma
according to Evans' criteria. The group included 11 male and 8 female
patients with a median age at diagnosis of 3.15 years (range, 1.03-7 years).
The primary tumor in all patients was retroperitoneal but included one jaw,
one thoracic, and one tumor of unknown origin. The patients initially had
bone and bone marrow involvement, except one who had bone marrow
invasion only. Induction treatment included OPEC/CADO (five patients), NB
84 (four patients), NB 85 (five patients), NB 86 (three patients) (1), ENSG
(European Neuroblastoma Study Group) B (two patients). Induction
duration was a median of 7.9 months (range, 4-11 months).
Surgical removal could be assessed in all but two patients (those with
tumors of jaw and tumors of unknown origin); there were five cases of
complete removal, nine of microscopic residue, two of macroscopic residue,
and one tumor was unresectable.
All patients received similar massive therapy including vincristine given
as a bolus injection on day 1 followed by a 24-hour infusion from days 1 to 5
(total 4 mg/m 2 ). High-dose melphalan (180 mg/m 2 ) was given on day 5.
Fractionated total body irradiation was delivered over 3 days in 6 fractions of 2
Gy, with lung protection at 10 Gy.
All bone marrow grafts had been purged by an immunomagnetic