Multimodal treatment including tandem high‐dose chemotherapy and autologous stem cell transplantation in children with anaplastic ependymomas

Abstract

In this study, we evaluated the results of multimodal treatment that included tandem HDCT/auto-SCT in children with anaplastic ependymomas. Fourteen patients with anaplastic ependymomas were enrolled from 2006 to 2014. Six cycles of induction chemotherapy were administered to all patients before they underwent tandem HDCT/auto-SCT. Patients who were older than 3 years of age were administered RT after two cycles of induction chemotherapy. In patients under 3 years of age, RT was either omitted or delayed until they reached 3 years of age, if the patients experienced CR after tandem HDCT/auto-SCT. All patients, including two who experienced disease progression during induction treatment, underwent the first HDCT/auto-SCT, and 13 subsequently underwent the second HDCT/auto-SCT. One patient died from hepatic VOD during the second HDCT/auto-SCT; other toxicities occurring during tandem HDCT/auto-SCT were manageable. Relapses or progression occurred in seven patients, and five of seven of them remain alive till date after salvage treatment, including surgery and RT. The 5-year overall and event-free survival rates were 85.1% ± 9.7% and 50.0% ± 13.4%, respectively. These findings suggest that multimodal treatment including tandem HDCT/auto-SCT could be a feasible option for improving survival in children with anaplastic ependymomas.

High‐dose chemotherapy with autologous stem cell transplantation in infants and young children with ependymoma: A 10‐year experience with the Head Start II protocol

“…For those >3 years old, after primary surgery, radiotherapy was sandwiched between chemotherapy and followed by HDC with ASCT. The 5-year OS and EFS rates were 85.1% ± 9.7% and 50.0% ± 13.4%, respectively 9. Our experience with HDC and ASCT in University Malaya Medical Center (UMMC) did not show promising result in infants and young children with ependymoma.…”

“…et al8 concluded that this approach seems to be ineffective in infratentorial ependymoma in the absence of radiotherapy and should be investigated further in supratentorial ependymoma with residual disease following surgery.Given this, we have read with interest the study by Lee et al,9 who described the favorable outcome with multimodal treatment including tandem HDC with ASCT and radiotherapy in children with anaplastic ependymomas. Two treatment regimens were used in their study.…”