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Does consolidation with autologous stem cell transplantation improve the outcome of children with metastatic or relapsed Ewing sarcoma?
Author(s) -
AlFaris Nafisah,
Al Harbi Talal,
Goia Cristina,
Pappo Alberto,
Doyle John,
Gassas Adam
Publication year - 2007
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.21140
Subject(s) - medicine , etoposide , autologous stem cell transplantation , ifosfamide , vincristine , topotecan , surgery , carboplatin , cyclophosphamide , sarcoma , melphalan , oncology , chemotherapy , ewing's sarcoma , cisplatin , pathology
Objective To evaluate the role of high‐dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) as consolidation therapy for children with high‐risk Ewing sarcoma (ES) treated at The Hospital for Sick Children (SickKids), Toronto. Patients and Methods The charts of children treated for high‐risk ES (defined as metastatic at diagnosis or relapsed) between 1990 and 2005 at SickKids were reviewed. Forty‐five children were identified. Twenty patients received ASCT after induction with vincristine, doxorubicin, ifosfamide, cyclophosphamide, and etoposide. Patients with resectable tumor or lung metastases underwent surgery and those with non‐resectable tumors were treated with irradiation. Twenty‐five patients were treated with conventional chemotherapy (CC). Primary metastatic patients were treated with either a local protocol or as per POG 9354. At relapse, patients were treated with topotecan, cyclophosphamide, then ifosfamide, carboplatin, and etoposide (ICE). Local control was attained with surgery and/or irradiation. Results Ten of the 20 patients treated with ASCT are alive (median follow‐up 6 years), with 8/10 being in remission more than 5 years from diagnosis. The 3‐year overall survival (OS) for ASCT was 59%, (95% CI: 36%, 81%) compared to 34% (14%, 53%) for patients treated with CC ( P ‐value = 0.06). The 3‐year event‐free survival (EFS) for the ASCT was 39% (17%, 60%) compared to 32% (13%, 50%) in the CC group ( P = 0.08). Conclusion ASCT appears to add some benefit to conventional multimodality therapy for children with high‐risk ES. Randomized controlled trials are warranted. Pediatr Blood Cancer 2007;49:190–195. © 2007 Wiley‐Liss, Inc.