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Outcome of patients with recurrent medulloblastoma or central nervous system germinoma treated with low dose continuous intravenous etoposide along with dose‐intensive chemotherapy followed by autologous hematopoietic stem cell rescue
Author(s) -
Grodman Howard,
Wolfe Lawrence,
Kretschmar Cynthia
Publication year - 2009
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.21985
Subject(s) - thiotepa , medicine , carboplatin , etoposide , medulloblastoma , germinoma , regimen , chemotherapy , surgery , ependymoma , carmustine , chemotherapy regimen , hematopoietic stem cell transplantation , transplantation , oncology , urology , pathology , cyclophosphamide , cisplatin
Background Adults and children with recurrent malignant central nervous system (CNS) tumors have a poor prognosis despite high dose chemotherapy with a conventional stem cell rescue regimen. In this study we evaluated the results of low dose, continuous infusion etoposide over 21 days added to a conventional high‐dose regimen of carboplatin and thiotepa in eight patients with relapsed pediatric CNS tumors. Procedure Patients with high risk CNS tumors were treated with etoposide 25 mg/m 2 /day by continuous intravenous (IV) infusion from day −22 to day −2, carboplatin 667 mg/m 2 /dose IV (or area under the curve = 9 mg/ml/min according to the Calvert formula on days −8, −7, and −6, and thiotepa 300 mg/m 2 /dose IV on days −5, −4, and −3, followed by autologous hematopoietic stem cell rescue on day 0. Results Eight adults and children, with a mean age of 12.9 years (age range 5.6–27.8 years), with relapsed primary CNS tumors (metastatic medulloblastoma (7), germinoma (1)), were enrolled. The mean survival post‐transplant was 4.8+ years, (range 8–160+ months). The 2‐ and 5‐year overall survival rates were 75% and 50% respectively. None of the survivors required additional salvage irradiation. Conclusion The strategy of low dose chronic exposure to a topoisomerase inhibitor along with ablative carboplatin and thiotepa with stem cell rescue showed promising survival outcomes in these relapsed patients. This treatment strategy deserves further evaluation in a larger group of high‐risk or relapsed primary CNS tumors. Pediatr Blood Cancer 2009;53:33–36. © 2009 Wiley‐Liss, Inc.