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Comprehensive treatment of advanced neuroblastoma involving autologous bone marrow transplant
Author(s) -
MUGISHIMA HIDEO,
HARADA KENSUKE,
SUZUKI TAKASHI,
CHIN MOTOAKI,
SHIMADA TOSHIAKI,
TAKAMURA MAYUMI,
SHICHINO HIROYUKI,
FUJISAWA TAKAHITO,
ICHIKAWA MASATAKA,
IWATA MITSUMASA,
OKABE IKUO,
SANUKI EIICHI,
TANAKA YOSHIAKI,
ONUMA NAOMI,
TANABE MASAHIRO,
OKAMATSU TAKAO,
KOIZUMI SHOICHI,
KAJIMOTO TERUHO,
SERINE ISAO,
OKADA NOBORU,
YOKOYAMA JOTARO,
KATO SYUNICHI,
SAEKI MORIHIRO,
AKATSUKA JUNICHI,
KIKUTA ATSUSHI,
TSUKIMOTO ICHIRO,
KITO HIDEYUKI,
MIMAYA JUNICHI,
FUJIMOTO TAKEO,
OHIRA MUTSURO,
KANEKO MICHIO,
TSUCHIDA YOSHIAKI
Publication year - 1995
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/j.1442-200x.1995.tb03361.x
Subject(s) - medicine , neuroblastoma , chemotherapy , bone marrow , surgery , retinoic acid , radiation therapy , oncology , chemistry , genetics , gene , biology , biochemistry , cell culture
Encouraging results are reported with high‐dose chemotherapy and total body irradiation followed by autologous bone marrow transplantation in the treatment of advanced neuroblastoma. However, relapse remains a significant problem. We used high‐dose chemotherapy, surgery, intraoperative radiation and an autologous bone marrow transplant treated in vitro to remove tumor cells followed by 13‐cis‐retinoic acid to treat 36 children with advanced neuroblastoma. This comprehensive treatment appears to improve the survival rate of patients with advanced neuroblastoma, including those with N‐myc amplification and bony involvement. The disease‐free survival rate was 66% (95% confidence interval, 49–84%) at 3 years. All patients who received 13‐cis‐retinoic acid developed cheilitis, but no bone marrow depression occurred in these patients. Five patients developed hemolytic uremic syndrome (HUS) post‐transplant. This may have been related to the procedure used for total body irradiation. Patients who had their kidneys shielded during this procedure did not develop this syndrome. Patients who received local irradiation at the primary site showed no evidence of relapse in this region, indicating that such therapy may help to prevent a relapse. These data suggest a high rate of 3 year disease‐free survival with this treatment strategy. The nonrandomized nature of the study and use of multiple modalities precludes analysis of the specific contribution of each.