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Experience with high dose multiagent chemotherapy and autologous bone marrow rescue in the treatment of twenty‐two children with advanced tumours
Author(s) -
EKERT H.,
TIEDEMANN K.,
WATERS K. D.,
ELLIS W. M.
Publication year - 1984
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.1984.tb00077.x
Subject(s) - medicine , mucositis , chemotherapy , bone marrow , surgery , complication , rhabdomyosarcoma , cyclophosphamide , bone marrow suppression , gastroenterology , sarcoma , pathology
Intensive chemotherapy followed by infusion of cryopreserved autologous bone marrow (ABMR) was used in the treatment of 22 children with advanced tumours. In nine this was their initial therapy; in eight it was used after partial or complete remission had been achieved with standard therapy; and in five, after relapse had occurred. Recovery of marrow function occurred in 20 patients with a mean time of 13.2 and 18.2 days to recovery of neutrophils (>0.5 × 10 9 /t) in newly diagnosed and previously treated patients respectively. Platelet count recovery to >50 × 10 9 /l occurred in a mean time of 13.4 days in newly diagnosed and 20.4 days in previously treated patients. Control of extensive local tumour was obtained in three of three evaluable patients with abdominal non‐Hodgkin's lymphoma (NHL). Metastatic bony and marrow disease was controlled in two of two patients with retinoblastoma. In Ewing's sarcoma, temporary control of widespread metastatic disease occurred in one patient. In the other, eradication of extensive local mass disease at the primary site had been achieved. Poor response to‐treatment has been seen in seven of eight patients with Stage III or IV rhabdomyosarcoma, three patients with neuroblastoma and four of five patients with recurrent disease Apart from the anticipated bone marrow toxicity, the major complications were severe mucositis, anaphylaxis following bone marrow infusion and haemorrhagic cystitis. The presence of herpes simplex infection appeared to aggravate mucosal complication. We suggest that intensive chemotherapy and ABMR has a place in the treatment of tumours in which there is evidence of sensitivity to high doses of cyclophosphamide, or where synergy of drugs such as cyclophosphamide and adnamycin may be expected to increase tumour cell kill. The ability to control extensive intra‐abdominal disease in NHL may eliminate the need for total abdominal irradiation in that disease.