J Korean Med Sci.  2009 Aug;24(4):660-667. 10.3346/jkms.2009.24.4.660.

High-dose Chemotherapy and Autologous Stem Cell Rescue in Patients with High-risk Stage 3 Neuroblastoma: 10-Year Experience at a Single Center

• Suh JM
• Yoo KH
• Sung KW
• Kim JY
• Cho EJ
• Koo HH
• Lee SK
• Kim J
• Lim DH
• Suh YL
• Kim DW

• KMID: 1779200
• DOI: http://doi.org/10.3346/jkms.2009.24.4.660

Abstract

High-dose chemotherapy and autologous stem cell rescue (HDCT/ASCR) was applied to improve the prognosis of patients with high-risk stage 3 neuroblastoma. From January 1997 to December 2006, 28 patients were newly diagnosed as stage 3 neuroblastoma. Nine of 11 patients with N-myc amplification and 5 of 17 patients without N-myc amplification (poor response in 2 patients, persistent residual tumor in 2 and relapse in 1) underwent single or tandem HDCT/ASCR. Patients without high-risk features received conventional treatment modalities only. While 8 of 9 patients underwent single HDCT/ASCR and the remaining one patient underwent tandem HDCT/ASCR during the early study period, all 5 patients underwent tandem HDCT/ASCR during the late period. Toxicities associated with HDCT/ASCR were tolerable and there was no treatment-related mortality. While the tumor relapsed in two of eight patients in single HDCT/ASCR group, all six patients in tandem HDCT/ASCR group remained relapse free. The 5-yr event-free survival (EFS) from diagnosis, in patients with N-myc amplification, was 71.6+/-14.0%. In addition, 12 of 14 patients who underwent HDCT/ASCR remained event free resulting in an 85.1+/-9.7% 5-yr EFS after the first HDCT/ASCR. The present study demonstrates that HDCT/ASCR may improve the survival of patients with high-risk stage 3 neuroblastoma.

Keyword

Neuroblastoma; High-dose Chemotherapy; Autologous Stem Cell Rescue; Prognosis; N-myc

MeSH Terms

Adolescent
Adult
Child
Combined Modality Therapy
Female
Granulocyte Colony Stimulating Factor, Recombinant/therapeutic use
Humans
Male
Middle Aged
Neoplasm Staging
Neuroblastoma/drug therapy/mortality/*therapy
*Peripheral Blood Stem Cell Transplantation
Proto-Oncogene Proteins c-myc/analysis/genetics
Survival Rate
Tomography, X-Ray Computed
Transplantation, Autologous

Figure

• 

  Fig. 1 Flow of the patients from diagnosis through HDCT/ASCR. All except two patients with N-myc amplification (early death in 1 and refusal to receive HDCT in 1) underwent HDCT/ASCR. In addition, 5 of 17 patients without N-myc amplification (poor response to chemotherapy in 2 patients, persistent gross residual tumor in 2 patients and relapse during chemotherapy in 1 patient) underwent HDCT/ASCR. Therefore, overall 14 patients underwent HDCT/ASCR. Eleven of 17 patients without N-myc amplification received conventional chemotherapy alone.

• 

  Fig. 2 Results of Kaplan-Meier analysis for the EFS in all 28 patients. The tumor relapsed in 3 out of 28 patients and there were 2 toxic deaths during conventional chemotherapy. Therefore, 23 out of 28 patients remained event free with a median follow-up of 63 months (range 12-129) from diagnosis. (A) The 5-yr EFS rate (±SE) after diagnosis for all 28 patients was 80.8±7.8%. (B) The 5-yr EFS rate for all 11 patients with N-myc amplification and 17 patients without was 71.6±14.0% and 87.8±8.1%, respectively.

• 

  Fig. 3 Results of Kaplan-Meier analysis for the EFS of 14 patients who underwent HDCT/ASCR. The tumor relapsed in 2 out of 14 patients and the remaining 12 patients remained event free with a median follow-up of 55 months (range 12-110) from the first HDCT/ASCR. (A) The 5-yr EFS rate after the first HDCT/ASCR for all 14 patients was 85.1±9.7%. (B) While tumor relapsed in 2 of 8 patients in single HDCT/ASCR group, all 6 patients in tandem HDCT/ASCR group remained event free.

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