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Treatment and outcomes of patients with relapsed, high‐risk neuroblastoma: Results of German trials
Author(s) -
Simon Thorsten,
Berthold Frank,
Borkhardt Arndt,
Kremens Bernhard,
De Carolis Boris,
Hero Barbara
Publication year - 2011
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.22693
Subject(s) - medicine , neuroblastoma , chemotherapy , autologous stem cell transplantation , surgery , stage (stratigraphy) , survival rate , salvage therapy , cell culture , paleontology , genetics , biology
Background The prognosis of high‐risk neuroblastoma patients has improved over the last decades. However, many patients experience relapse after successful initial treatment. We retrospectively analyzed the long‐term outcome of relapsed patients of three consecutive national neuroblastoma trials. Methods Patients were included when they fulfilled all of the following criteria: Age at diagnosis being 1 year or older, first diagnosis between 1990 and 2007, stage 4 disease or stage 3 neuroblastoma with MYCN amplification, and relapse or progression after successful first‐line autologous stem cell transplantation (ASCT). Results A total of 451 high‐risk neuroblastoma patients 1 year or older underwent ASCT during first‐line treatment, 253 experienced recurrence of disease, 158 received salvage chemotherapy, and 23 of them finally underwent a second ASCT. These 23 patients had a better median survival (2.08 years) and 3‐year survival rate from recurrence (43.5 ± 10.9%) compared to 74 patients who had no second chemotherapy (median survival 0.24 years, 3‐year survival rate 4.0 ± 2.6%) and 135 patients who underwent second‐line chemotherapy but did not undergo second ASCT (median survival of 0.89 years, 3‐year survival rate 9.6 ± 2.8%, P < 0.001). By February 2010, 3/23 patients were in complete remission, 3/23 in very good partial remission, 1/23 in partial remission, 14/23 patients died of disease after successful second ASCT, and 2/23 died of complications due to second ASCT. Conclusion Intensive second‐line therapy is feasible. A small subgroup of relapsed high‐risk neuroblastoma patients may benefit from intensive relapse chemotherapy and second ASCT. The potential of long‐term survival justifies clinical trials on intensive second‐line treatment. Pediatr Blood Cancer 2011;56:578–583. © 2010 Wiley‐Liss, Inc.