Autologous Bone Marrow Transplantation - Blog Science Connections

ABMT in Neuroblastoma 421
procedure described elsewhere (3; see also Combaret et al. "Eliminating
Burkitt's Cells From Excess Bone Marrow With an Immunomagnetic Purging
Procedure," this volume), except for two patients who received a T-cell
depleted allograft and one whose marrow had been treated by 6-OH
dopamine.
At the time of intensive consolidation, which was always performed after
surgery, and 2 months thereafter, patients were defined as in CR, VGPR, or PR
according to criteria outlined above.
All in group 2 had stage IV disease. Age at diagnosis was 2.7 years
(range, 1 -4.6 years), and the gender ratio was 2:2. The patients' primary
tumors were located in the retroperitoneum. The induction regimen
consisted of PE/CADO (three patients) or ENSG III C (one patient). Before
the graft could be done, all patients died between 4 and 7 months after
treatment had begun.
Group 3 patients were at stage IV, except for two at stage III who had had
grossly incomplete surgery, and one who had a localized esthesioneuroblastoma
(second cancer). There were seven males and three females, the
age at diagnosis being 5.41 years (range, 0.10-18 years). All patients'
primary tumors were located in the retroperitoneal region except for the
temporal esthesioneuroblastoma. Most stage IV patients had bone and bone
marrow metastasis, but two patients had only bone, and one had only bone
marrow invasion. Induction treatment was heterogeneous because most
patients had been referred from elsewhere. Induction duration was 10.4
months (5-15 months). Surgical removal of tumor could be assessed in
seven patients: three had complete removal, one had microscopic residue,
one had macroscopic residue, and two tumors were unresectable.
Massive therapy consisted of one or two ABMT: five patients received
only one graft. Two had the same conditioning as in group 1, one of them
receiving a local boost of 20 Gy to the primary tumor. One patient underwent
similar conditioning, omitting total body irradiation because he had had
previous local irradiation for the esthesioneuroblastoma. One patient
received VM-26 (teniposide), carboplatinum, and high-dose melphalan (see
below for dosages) because of young age at diagnosis. One patient received
carmustine (BCNC1), teniposide, and cisplatin (see below) and a local 24-Gy
boost because of young age at diagnosis. Five patients received one or the
first of two successive high-dose chemotherapy protocols followed by ABMT.
The first conditioning regimen included BCNCJ (300 mg/m 2
in i.v. bolus on
day 10), teniposide (250 mg/m 2 in i.v. bolus on days 2-5), and cisplatin (40
mg/m 2
in i.v. bolus on days 2-6) with marrow infusion on day 7. The second
graft followed the same schedule as described for group 1.
Three patients have completed the two courses, and two patients have
received only one graft as of now.
All patients received immunomagnetically purged marrow once or twice.
Only the patient with an esthesioneuroblastoma received unpurged marrow.