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Treatment of high‐risk relapsed Wilms tumor with dose‐intensive chemotherapy, marrow‐ablative chemotherapy, and autologous hematopoietic stem cell support: Experience by the Italian association of pediatric hematology and oncology
Author(s) -
Spreafico Filippo,
Bisogno Gianni,
Collini Paola,
Jenkner Alessandro,
Gandola Lorenza,
D'Angelo Paolo,
Casazza Gabriella,
Piva Luigi,
Luksch Roberto,
Perotti Daniela,
Pession Andrea,
Fagioli Franca,
Dallorso Sandro
Publication year - 2008
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.21524
Subject(s) - medicine , etoposide , chemotherapy , carboplatin , wilms' tumor , hematopoietic stem cell transplantation , surgery , ifosfamide , hematology , oncology , transplantation , cisplatin
Background We evaluated an intensified chemotherapy strategy in children with Wilms tumor who relapsed with high‐risk features. Procedures From January 2001 to June 2006, we treated 20 consecutive children with reinduction chemotherapy (using ifosfamide/carboplatin/etoposide in 15/20 cases), with (n = 15) or without (n = 5) subsequent high‐dose chemotherapy and hematopoietic stem cell support, surgery where feasible, and radiation therapy. The median time to relapse was 10 months after nephrectomy. All but two children initially received doxorubicin as first‐line therapy. Results All patients were assessed for outcome: 13 are currently alive, 12 of them in remission a median 25 months since their relapse, one with progressing tumor. The treatment was unsuccessful in eight children: the disease progressed during reinduction in three, and relapsed in five. There was one toxic death. All transplanted patients engrafted to a neutrophil count >0.5 × 10 3 /µl after a median 11 days, and to an unsustained platelet count >25,000/µl after a median of 13 days. Three‐year disease‐free and overall survival rates were 56 ± 12% and 55 ± 13%, respectively. Neither recurrence within 12 months of nephrectomy nor extra‐lung recurrence negatively affected outcome. A survival advantage was demonstrated in patients without disease evidence prior to transplant. Conclusion A disease‐free survival rate nearing 50% is a realistic target in children with high‐risk recurrent Wilms tumor. The benefit of autologous hematopoietic stem cell transplantation for consolidation deserves to be investigated in a randomized, controlled study. Pediatr Blood Cancer 2008;51:23–28. © 2008 Wiley‐Liss, Inc.