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Malinowska I, Romiszewski M, Smalisz K, Stelmaszczyk-Emmel A, Nasilowska-Adamska B, Krol M, Urbanowska E, Brozyna A, Baginska-Dembowska B. Plerixafor combined with G-CSF for stem cell mobilization in children qualified for autologous transplantation- single center experience. Transfus Apher Sci 2021; 60:103077. [PMID: 33583716 DOI: 10.1016/j.transci.2021.103077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/16/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Failure of autologous peripheral blood CD34+ stem cells collection can adversely affect the treatment modality for patients with hematological and nonhematological malignant diseases where high dose chemotherapy followed by hematopoietic stem cell transplantation has become part of their treatment. Plerixafor in conjunction with G-CSF is approved for clinical use as a mobilization agent. The clinical efficacy of Plerixafor in CD34+ cells collection was analyzed in our institution. A total of 13 patients aged 1-15,5 years received Plerixafor in combination with G-CSF: 7 with neuroblastoma, 2 with Ewing's sarcoma and single patients with Hodgkin's lymphoma, germ cell tumor, retinoblastoma and Wilms tumor. Twelve patients (923%) achieved CD34+ cell counts of ≥ 20 × 106/L after 1-7 doses of Plerixafor. The average 9,9 - fold increase in number of CD34+ cells were achieved following the first dose and 429 - fold after second dose of plerixafor. Among the 13 patients, 12 yielded the minimum required cell collection of 2 × 106/kg within an average of 2 doses of Plerixafor. The mean number of apheresis days was 1.75. The median total number of collected CD34+ cells was 982 × 106/kg. Plerixafor enables rapid and effective mobilization, and collection of sufficient number of CD34+ cells.
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Affiliation(s)
- Iwona Malinowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Michal Romiszewski
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Katarzyna Smalisz
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Anna Stelmaszczyk-Emmel
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Barbara Nasilowska-Adamska
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland Indiry Gandhi str. 14, 02-776 Warsaw, Poland.
| | - Malgorzata Krol
- Stem Cell Bank, Central Clinical Hospital Warsaw Medical University, Poland, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Elzbieta Urbanowska
- Stem Cell Bank, Central Clinical Hospital Warsaw Medical University, Poland, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Agnieszka Brozyna
- Department of Pediatrics Oncology, Children's Memorial Health Institute, Warsaw, Poland, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland.
| | - Bozenna Baginska-Dembowska
- Department of Pediatrics Oncology, Children's Memorial Health Institute, Warsaw, Poland, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland.
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Assessment of Organ Dosimetry for Planning Repeat Treatments of High-Dose 131I-MIBG Therapy: 123I-MIBG Versus Posttherapy 131I-MIBG Imaging. Clin Nucl Med 2018; 42:741-748. [PMID: 28759518 DOI: 10.1097/rlu.0000000000001752] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate detailed organ-based radiation-absorbed dose for planning double high-dose treatment with I-MIBG. METHODS In a prospective study, 33 patients with high-risk refractory or recurrent neuroblastoma were treated with high-dose I-MIBG. Organ dosimetry was estimated from the first I-MIBG posttherapy imaging and from subsequent I-MIBG imaging prior to the planned second administration. Three serial whole-body scans were performed per patient 2 to 6 days after I-MIBG therapy (666 MBq/kg or 18 mCi/kg) and approximately 0.5, 24, and 48 hours after the diagnostic I-MIBG dose (370 MBq/kg or 10 mCi/1.73 m). Organ radiation doses were calculated using OLINDA. I-MIBG scan dosimetry estimations were used to predict doses for the second I-MIBG therapy and compared with I-MIBG posttherapy estimates. RESULTS Mean ± SD whole-body doses from I-MIBG and I-MIBG scans were 0.162 ± 112 and 0.141 ± 0.068 mGy/MBq, respectively. I-MIBG and I-MIBG organ doses were variable-generally higher for I-MIBG-projected doses than those projected using posttherapy I-MIBG scans. Mean ± SD doses to liver, heart wall, and lungs were 0.487 ± 0.28, 0.225 ± 0.20, and 0.40 ± 0.26, respectively, for I-MIBG and 0.885 ± 0.56, 0.618 ± 0.37, and 0.458 ± 0.56, respectively, for I-MIBG. Mean ratio of I-MIBG to I-MIBG estimated radiation dose was 1.81 ± 1.95 for the liver, 2.75 ± 1.84 for the heart, and 1.13 ± 0.93 for the lungs. No unexpected toxicities were noted based on I-MIBG-projected doses and cumulative dose limits of 30, 20, and 15 Gy to liver, kidneys, and lungs, respectively. CONCLUSIONS For repeat I-MIBG treatment planning, both I-MIBG and I-MIBG imaging yielded variable organ doses. However, I-MIBG-based dosimetry yielded a more conservative estimate of maximum allowable activity and would be suitable for planning and limiting organ toxicity with repeat high-dose therapies.
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Whittle SB, Smith V, Doherty E, Zhao S, McCarty S, Zage PE. Overview and recent advances in the treatment of neuroblastoma. Expert Rev Anticancer Ther 2017; 17:369-386. [PMID: 28142287 DOI: 10.1080/14737140.2017.1285230] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Children with neuroblastoma have widely divergent outcomes, ranging from cure in >90% of patients with low risk disease to <50% for those with high risk disease. Recent research has shed light on the biology of neuroblastoma, allowing for more accurate risk stratification and treatment reduction in many cases, although newer treatment strategies for children with high-risk and relapsed neuroblastoma are needed to improve outcomes. Areas covered: Neuroblastoma epidemiology, diagnosis, risk stratification, and recent advances in treatment of both newly diagnosed and relapsed neuroblastoma. Expert commentary: The identification of newer tumor targets and of novel cell-mediated immunotherapy agents may lead to novel therapeutic approaches, and clinical trials for regimens designed to target individual genetic aberrations in tumors are underway. A combination of therapeutic modalities will likely be required to improve survival and cure rates for patients with high-risk neuroblastoma.
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Affiliation(s)
- Sarah B Whittle
- a Department of Pediatrics, Section of Hematology-Oncology , Texas Children's Cancer and Hematology Centers, Baylor College of Medicine , Houston , TX , USA
| | - Valeria Smith
- a Department of Pediatrics, Section of Hematology-Oncology , Texas Children's Cancer and Hematology Centers, Baylor College of Medicine , Houston , TX , USA
| | - Erin Doherty
- a Department of Pediatrics, Section of Hematology-Oncology , Texas Children's Cancer and Hematology Centers, Baylor College of Medicine , Houston , TX , USA
| | - Sibo Zhao
- a Department of Pediatrics, Section of Hematology-Oncology , Texas Children's Cancer and Hematology Centers, Baylor College of Medicine , Houston , TX , USA
| | - Scott McCarty
- b Department of Pediatrics, Division of Hematology-Oncology , University of California San Diego, La Jolla, CA and Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital , San Diego , CA , USA
| | - Peter E Zage
- b Department of Pediatrics, Division of Hematology-Oncology , University of California San Diego, La Jolla, CA and Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital , San Diego , CA , USA
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Bitan M, Eshel R, Sadot E, Friedman S, Pinhasov A, Levin D, Dvir R, Manisterski M, Berger-Achituv S, Rosenfeld-Keidar H, Elhasid R. Combined plerixafor and granulocyte colony-stimulating factor for harvesting high-dose hematopoietic stem cells: Possible niche for plerixafor use in pediatric patients. Pediatr Transplant 2016; 20:565-71. [PMID: 26991903 DOI: 10.1111/petr.12692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 01/05/2023]
Abstract
PB is a source of HSC, especially for autologous HCT in solid tumors. However, there is a risk of failing to achieve the target number of SC after mobilization with growth factors alone in patients who were heavily pretreated with chemotherapy or those in need for tandem transplants. SC were harvested from seven pediatric patients with solid tumors who were in need of autologous HCT following combination GCSF and plerixafor. Six of them received plerixafor after failing to achieve enough SC with GCSF only, while the seventh patient received the combined protocol upfront. All seven patients achieved the target number of SC according to their treatment protocol. There were no adverse events. All patients underwent autologous HCT using the harvested HSC and achieved full engraftment. A protocol for harvesting autologous HCT using GCSF and plerixafor is feasible and safe in children with solid tumors who had been heavily pretreated with chemotherapy or needed tandem transplants.
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Affiliation(s)
- Menachem Bitan
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rinat Eshel
- Hematology & BMT Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Efraim Sadot
- Pediatric Intensive Care Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shirley Friedman
- Pediatric Intensive Care Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviva Pinhasov
- Hematology & BMT Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dror Levin
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rina Dvir
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Manisterski
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sivan Berger-Achituv
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hila Rosenfeld-Keidar
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Elhasid
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Treatment of high-risk neuroblastoma in children: recent clinic trial results. ACTA ACUST UNITED AC 2013. [DOI: 10.4155/cli.13.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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5-day/5-drug myeloablative outpatient regimen for resistant neuroblastoma. Bone Marrow Transplant 2012; 48:642-5. [PMID: 23085829 DOI: 10.1038/bmt.2012.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
5-day/5-drug (5D/5D) is a novel high-dose regimen administered with autologous hematopoietic SCT (HSCT). It was designed to maximize cytoreduction via high dosing of synergistically interacting agents, while minimizing morbidity in patients with resistant neuroblastoma (NB) and ineligible for clinical trials due to myelosuppression from previous therapy. 5D/5D comprises carboplatin 500 mg/m(2)/day on days 1-2, irinotecan 50 mg/m(2)/day on days 1-3, temozolomide 250 mg/m(2)/day on days 1-3, etoposide 200 mg/m(2)/day on days 3-5 and cyclophosphamide 70 mg/kg/day on days 4-5. HSCT is on day 8. Sixteen patients received 21 courses. Treatment was in the outpatient clinic. Responses were noted against progressive disease (PD) that had developed while patients were off, or receiving only low-dose, chemotherapy but not against PD that emerged despite high-dose chemotherapy. Responses were also seen in patients with PD or stable disease after (131)I-metaiodobenzylguanidine therapy. Grade 3 toxicities were limited to transient elevations in liver enzymes (three courses) and hyponatremia (one course). Bacteremia occurred in 2/21 (10%) courses. Hematological recovery allowed patients to be enrolled on clinical trials. In conclusion, 5D/5D (including HSCT) spares vital organs, entails modest morbidity, shows activity against resistant NB and helps patients meet eligibility requirements for formal clinical trials.
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Kushner BH, Modak S, Kramer K, Basu EM, Roberts SS, Cheung NKV. Ifosfamide, carboplatin, and etoposide for neuroblastoma. Cancer 2012; 119:665-71. [DOI: 10.1002/cncr.27783] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/05/2012] [Accepted: 07/13/2012] [Indexed: 11/10/2022]
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Modak S, Cheung IY, Kushner BH, Kramer K, Reich L, Cheung NKV. Plerixafor plus granulocyte-colony stimulating factor for autologous hematopoietic stem cell mobilization in patients with metastatic neuroblastoma. Pediatr Blood Cancer 2012; 58:469-71. [PMID: 21416584 DOI: 10.1002/pbc.23132] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 02/24/2011] [Indexed: 01/14/2023]
Abstract
Current therapies for high-risk neuroblastoma (NB) necessitate the availability of several aliquots of autologous peripheral blood stem cells to reverse-associated myelosuppression. Priming with the CXCR4 inhibitor plerixafor plus G-CSF was associated with successful stem cell harvest in 5/7 heavily prior-treated patients with stage 4 NB who had previously failed G-CSF priming. Minimal residual disease was not detected in harvested cells from any patient despite the presence of disease in bone/bone marrow in 6/7. Hematopoietic reconstitution was achieved in all three patients receiving plerixafor-primed stem cells after myeloablative therapy. Plerixafor is an effective and safe agent for stem cell collection in patients with NB.
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Affiliation(s)
- Shakeel Modak
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Kushner BH, Kramer K, Modak S, Cheung NKV. High-dose carboplatin-irinotecan-temozolomide: treatment option for neuroblastoma resistant to topotecan. Pediatr Blood Cancer 2011; 56:403-8. [PMID: 21049517 DOI: 10.1002/pbc.22855] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We report a retrospective study of a novel regimen for neuroblastoma (NB) resistant to standard induction or salvage chemotherapy which now routinely includes topotecan. PATIENTS AND METHODS Forty-five patients received carboplatin (500 mg/m(2)/day, 2×)-irinotecan (50 mg/m(2)/day, 5×)-temozolomide (250 mg/m(2)/day, 5×) (HD-CIT). Only one course was planned. Patients with thrombocytopenia indicative of poor bone marrow (BM) reserve resulting from extensive prior therapy received peripheral blood stem cells (PBSCs) post-HD-CIT. RESULTS Modest acute toxicity allowed outpatient treatment. Low-grade diarrhea was common; there was no mucositis, nephrotoxicity, or cardiotoxicity. Myelosuppression was prolonged but uncomplicated. The absolute neutrophil count reached 500/µl on days 20-30 (median, 25) in 25 patients with satisfactory BM reserve, and on days 9-14 (median, 11) post-PBSC infusion. Anti-NB activity was common against refractory (non-progressing) disease or new relapse occurring off therapy (68% objective response rate), but not against disease progressing on therapy. Seven of 26 patients treated for refractory NB are progression-free and in complete remission following subsequent therapy, including anti-G(D2) immunotherapy, at ≥ 29+ months post-HD-CIT. CONCLUSIONS HD-CIT is appealing as salvage or consolidative therapy because of anti-NB activity and modest non-hematologic toxicity. PBSC support is unnecessary when BM reserve is intact. The wide antineoplastic activity of its three components and their potential for activity against disease in the central nervous system support applicability to other cancers.
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Affiliation(s)
- Brian H Kushner
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
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High-dose cyclophosphamide-irinotecan-vincristine for primary refractory neuroblastoma. Eur J Cancer 2010; 47:84-9. [PMID: 20934323 DOI: 10.1016/j.ejca.2010.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 09/03/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND We used a novel regimen for neuroblastoma (NB) that had responded inadequately to standard chemotherapy which now includes topotecan in induction or second-line therapy. PATIENTS AND METHODS We retrospectively studied 38 patients who received one or two courses of high-dose cyclophosphamide (140 mg/kg)-irinotecan (CPT-11) (250 mg/m(2))-vincristine (HD-CCV) as treatment for NB that had responded incompletely to induction but had never progressed. Treatment was outpatient and was preceded and followed by extent-of-disease and toxicity evaluations because the patients were being considered for enrolment on formal protocols. Progression-free survival (PFS) was calculated from day 1 of HD-CCV. RESULTS Common toxicities were grade 4 myelosuppression and grade 2 diarrhoea. Responses--5 complete (CR), 3 partial (PR), 4 mixed (MR)--occurred in 12/28 (43%) patients treated ≤9 months, and in 1/10 (10%) patients treated >10 months, from diagnosis. HD-CCV was the initial salvage regimen after topotecan-containing induction in 5 patients, achieving 1 CR, 1 MR and 3 stable disease (NR). HD-CCV produced responses (2 PR, 3 MR) in all 5 patients previously treated with CPT-11/ temozolomide. In contrast, all 6 patients treated post-HD-CCV with CPT-11/temozolomide had NR to the latter. Post-HD-CCV treatments included immunotherapy, targeted radiotherapy and/or chemotherapy. PFS was 64% (±8%) at 24 months, with 20 patients progression-free at 2+-to-36+ (median 16+) months and 10 in first CR at 9+-to-36+ (median 16+) months. CONCLUSIONS HD-CCV offers a treatment option against topotecan-resistant NB. Results support the concept that combining CPT-11 with very high doses of alkylators can yield greater antitumour effect.
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Bensimhon P, Villablanca JG, Sender LS, Matthay KK, Park JR, Seeger R, London WB, Yap JSF, Kreissman SG. Peripheral blood stem cell support for multiple cycles of dose intensive induction therapy is feasible with little risk of tumor contamination in advanced stage neuroblastoma: a report from the Childrens Oncology Group. Pediatr Blood Cancer 2010; 54:596-602. [PMID: 20049927 PMCID: PMC2905158 DOI: 10.1002/pbc.22344] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Poor outcome in Stage 4 neuroblastoma may be improved with increased dose intensity of therapy. We investigated the feasibility of sequential collection and infusion of peripheral blood stem cells (PBSCs) as hematopoietic support for non-myeloablative dose intensive induction chemotherapy given every 21-28 days. METHODS Twenty-two children with Stage 4 neuroblastoma (>or=1 year of age) received two cycles of high-dose cyclophosphamide (4 g/m(2)), doxorubicin (75 mg/m(2)), and vincristine (2 mg/m(2)) followed by three cycles of interpatient dose escalating carboplatin (Dose Level 0 = 800 mg/m(2); Dose Level 1 = 1,000 mg/m(2)), high-dose cyclophosphamide (4 g/m(2)), and etoposide (600 mg/m(2)). PBSC were harvested following cycle 2, 3, and 4 in Cohort 1 and infused after each subsequent cycle. In Cohort 2, PBSC were harvested after cycle 2 and split into three aliquots for infusion. Dose limiting toxicity (DLT) and ability to administer cycles within 28 days was assessed. RESULTS Sufficient PBSC (>or=2 x 10(6) CD34 cells/kg per infusion) were collected from 17/21 eligible patients with minimal toxicity and no detectable neuroblastoma cells by immunocytology. Carboplatin at 1000 mg/m(2) resulted in DLT of delayed platelet recovery >28 days in 4/8 patients. Despite de-escalation to 800 mg/m(2), platelet DLT occurred in 4/7 Cohort 1 and 3/7 Cohort 2 patients. CONCLUSION As defined in this protocol, doses of carboplatin were not tolerable with the PBSC dose administered. However, it was feasible to collect sufficient PBSC from small neuroblastoma patients to use as hematopoietic support with minimal risk of tumor contamination and toxicity.
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Affiliation(s)
- Pamela Bensimhon
- Division of Pediatric Hematology/Oncology, Duke University Medical Center, Durham, NC
| | - Judith G. Villablanca
- Dept Pediatrics, USC Keck School of Medicine, Childrens Hospital Los Angeles, Los Angeles CA
| | - Leonard S. Sender
- Division of Pediatric Hematology/Oncology, Childrens Hospital of Orange County, Orange, CA
| | | | - Julie R. Park
- Department of Pediatrics, University of Washington and Seattle Childrens Hospital
| | - Robert Seeger
- Dept Pediatrics, USC Keck School of Medicine, Childrens Hospital Los Angeles, Los Angeles CA
| | | | | | - Susan G. Kreissman
- Division of Pediatric Hematology/Oncology, Duke University Medical Center, Durham, NC
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Abstract
Since the 1950s, the overall survival of children with cancer has gone from almost zero to approaching 80%. Although there have been notable successes in treating solid tumors such as Wilms tumor, some childhood solid tumors have continued to elude effective therapy. With the use of megatherapy techniques such as tandem transplantation, dose escalation has been pushed to the edge of dose-limiting toxicities, and any further improvements in event-free survival will have to be achieved through novel therapeutic approaches. This article reviews the status of autologous and allogeneic hematopoietic stem cell transplantation (HSCT) for many pediatric solid tumor types. Most of the clinical experience in transplant for pediatric solid tumors is in the autologous setting, so some general principles of autologous HSCT are reviewed. The article then examines HSCT for diseases such as Hodgkin disease, Ewing sarcoma, and neuroblastoma, and the future of cell-based therapies by considering some experimental approaches to cell therapies.
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Peters C, Cornish JM, Parikh SH, Kurtzberg J. Stem cell source and outcome after hematopoietic stem cell transplantation (HSCT) in children and adolescents with acute leukemia. Pediatr Clin North Am 2010; 57:27-46. [PMID: 20307710 DOI: 10.1016/j.pcl.2010.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation from siblings, unrelated donors or HLA mismatched family members has become an important procedure to offer a chance of cure to children and adolescents with acute leukemia at high risk of relapse and those with certain genetic diseases. Bone marrow (BM) was the only stem cell source for many years. During the past 15 years, peripheral blood stem cells from granulocyte colony-stimulating factor (G-CSF) mobilized healthy donors, or umbilical cord blood from related or unrelated donors, have become available. Each stem cell source has different risks/benefits for patients and donors, the choice depending not only on availability, but also on HLA compatibility and urgency of the HSCT. This review will analyze the advantages and limitations of each of these options, and the main criteria which can be applied when choosing the appropriate stem cell source for pediatric transplant recipients with acute leukemia.
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Affiliation(s)
- Christina Peters
- Stem Cell Transplantation Unit, St Anna Children's Hospital, Kinderspitalgasse 6, A-1090 Vienna, Austria.
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Trotman J, Presgrave P, Kwan Y, Tiley C, Estell J, Watson AM, O’Brien TA, Peters D. Consensus guidelines for ‘rainy day’ autologous stem cell harvests in New South Wales. Intern Med J 2008; 38:229-34. [DOI: 10.1111/j.1445-5994.2008.01632.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
High-risk neuroblastoma is a childhood malignancy with a poor prognosis. Gradual improvements in survival have correlated with therapeutic intensity, and the ability to harvest, process and store autologous hematopoietic stem cells has allowed for dose intensification beyond marrow tolerance. The use of high-dose chemotherapy with autologous hematopoietic stem cell rescue in consolidation has resulted in improvements in survival, although further advances are still needed. Newer approaches to SCT and supportive care, most notably the transition to PBSC, have resulted in further improvement in survival and decreases in treatment-related mortality. Research into experimental approaches to hematopoietic SCT is ongoing.
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