A study of sequential high dose cyclophosphamide and high dose carboplatin with peripheral stem-cell rescue in resistant or recurrent pediatric brain tumors

Foreman, Nicholas K.; Schissel, Debra; Le, Tuan; Strain, John D.; Fleitz, Julie; Quinones, Ralph; Giller, Roger

doi:10.1007/s11060-004-1366-2

Cited by 22 publications

(14 citation statements)

References 25 publications

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“…Two-year survival rates for relapsed medulloblastoma were reported to be below 20% (8). Recently, sequential cycles of dose-intensive chemotherapy or tandem transplantation have been tried in the treatment of chemo-sensitive high-risk or recurrent brain tumors, including recurrent medulloblastoma (9-11). The survival rate was reported as a broad range, 5-54%, by studies done in various different situations with regard to pre-transplant conventional chemotherapy, conditioning regimens, disease status prior to HDCT, and adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The recent study by Cheuk et al reported that 5 patients with PR disease status before HDCT, who had a median 8-month disease free period, did not survive a long-term (12, 14). However some researchers suggest that using multiple sequential intensive therapy or tandem transplantation has some benefit in this disease status before HDCT, because a single application of HDCT cannot eradicate the disease (9). Sung et al (10) reported that of 9 patients with PR status before HDCT, whose tumors were high-risk or relapsed medulloblastoma and supratentorial primitive neuroectodermal tumor, 8 who received tandem transplantation were alive with a median follow-up of 18 month and 7 of those were disease free.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of High-dose Chemotherapy and Autologous Stem Cell Transplantation in Patients with Relapsed Medulloblastoma: A Report on The Korean Society for Pediatric Neuro-Oncology (KSPNO)-S-053 Study

et al. 2010

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The efficacy and toxicity of high-dose chemotherapy and autologous stem cell transplantation (HDCT/ASCT) were investigated for improving the outcomes of patients with relapsed medulloblastoma. A total of 15 patients with relapsed medulloblastoma were enrolled in the KSPNO-S-053 study from May 2005 to May 2007. All patients received approximately 4 cycles of salvage chemotherapy after relapse. Thirteen underwent HDCT/ASCT; CTE and CM regimen were employed for the first HDCT (HDCT1) and second HDCT (HDCT2), respectively, and 7 underwent HDCT2. One transplant related mortality (TRM) due to veno-occlusive disease (VOD) occurred during HDCT1 but HDCT2 was tolerable with no further TRM. The 3-yr overall survival probability and event-free survival rates ±95% confidence intervals (CI) were 33.3±12.2% and 26.7% ±11.4%, respectively. When analysis was confined to only patients who had a complete response (CR) or partial response (PR) prior to HDCT, the probability of 3-yr overall survival rates ±95% CI was 40.0±15.5%. No patients with stable disease (SD) or progressive disease (PD) survived. Survival rates from protocol KSPNO-S-053 are encouraging and show that tumor status prior to HDCT/ASCT is an important factor to consider for improving survival rates of patients with relapsed medulloblastoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of High-dose Chemotherapy and Autologous Stem Cell Transplantation in Patients with Relapsed Medulloblastoma: A Report on The Korean Society for Pediatric Neuro-Oncology (KSPNO)-S-053 Study

et al. 2010

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“…After detailed review of those 31 articles, only 11 of them fulfilled the inclusion criteria ( Fig. 1; Table 1) [16][17][18][19][20][21][22][23][24][25][26]. Four out of eleven studies were prospective series, none of them was a randomized controlled trial.…”

Section: Included Studiesmentioning

confidence: 99%

Is there a role for high dose chemotherapy with hematopoietic stem cell rescue in patients with relapsed supratentorial PNET?

2011

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Supratentorial primitive neuroectodermal tumors (sPNET) are rare childhood brain tumors. There is no standard strategy for treating relapsed sPNETs. The role of high dose chemotherapy with hematopoietic stem cell rescue (HDC with HSCR) in treating relapsed sPNET is controversial. A systematic review of the literature regarding outcome of patients with relapsed sPNET treated with HDC and HSCR was performed to examine the potential predictive factors that would justify its use in this subset of patients. Forty-six patients were identified fulfilling the inclusion criteria. Of those, 15 patients were infants and 15 were pineoblastomas. With a median follow-up of 40 months (range 3-123 months) 15 patients were reported alive. Thirteen patients out of the 15 survivors did not receive craniospinal irradiation (CSRT). The 12 month overall survival (OS) of the cohort was 44.2 ± 7.5 months. Twelve-month OS for children less than 36 months was 66.7 ± 12.2 months while for older children it was 27.8 ± 10.6 (P = 0.003). Twelve-month OS was 20.0 ± 10.3 for those patients with pineoblastoma versus 54.6 ± 9.0 for those with non-pineal sPNETs (P < 0.001). Cox regression analysis revealed pineal location as the only independent adverse prognostic factor. In conclusion high dose chemotherapy with HSCR might lead to survival primarily in younger children with relapsed sPNET even in the absence of concomitant use of radiotherapy, whereas the outcome in older children and/or in pineal location is extremely poor with this modality.

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“…The median duration of tumor response was 10 months (range: 1.5–87 months), with two children disease-free at 66 and 87 months. Actuarial survival was only 21% (Foreman et al, 2005). That said, chemotherapy has vastly improved the outlook for children with medulloblastoma and has afforded delay of institution of radiation therapy in infants with brain tumors, decreasing somewhat the toxic effects of radiation to the developing brain (Gottardo and Gajjar, 2008).…”

Section: Brain Tumorsmentioning

confidence: 99%

New approaches to pharmacotherapy of tumors of the nervous system during childhood and adolescence

Schor

2009

Pharmacology & Therapeutics

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Tumors of the nervous system are among the most common and most chemoresistant neoplasms of childhood and adolescence. Malignant tumors of the brain collectively account for 21% of all cancers and 24% of all cancer-related deaths in this age group. Neuroblastoma, a peripheral nervous system tumor, is the most common extracranial solid tumor of childhood, and 65% of children with this tumor have only a 10 or 15% chance of living 5 years beyond the time of initial diagnosis. Novel pharmacological approaches to nervous system tumors are urgently needed. This review presents the role of and current challenges to pharmacotherapy of malignant tumors of the nervous system during childhood and adolescence and discusses novel approaches aimed at overcoming these challenges.

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A study of sequential high dose cyclophosphamide and high dose carboplatin with peripheral stem-cell rescue in resistant or recurrent pediatric brain tumors

Abstract: The MTD of carboplatin with stem-cell rescue is 700 mg/m2/day for 3 days. Sequential stem-cell supported cyclophosphamide and carboplatin was tolerable in children with brain tumors and produced responses in PNETs and Germinomas.

Cited by 22 publications

References 25 publications

Efficacy of High-dose Chemotherapy and Autologous Stem Cell Transplantation in Patients with Relapsed Medulloblastoma: A Report on The Korean Society for Pediatric Neuro-Oncology (KSPNO)-S-053 Study

Efficacy of High-dose Chemotherapy and Autologous Stem Cell Transplantation in Patients with Relapsed Medulloblastoma: A Report on The Korean Society for Pediatric Neuro-Oncology (KSPNO)-S-053 Study

Is there a role for high dose chemotherapy with hematopoietic stem cell rescue in patients with relapsed supratentorial PNET?

New approaches to pharmacotherapy of tumors of the nervous system during childhood and adolescence

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