Autologous bone marrow transplantation for pediatric Wilms' tumor: The experience of the European bone marrow transplantation solid tumor registry

Abstract

This survey includes 25 children with Wilms' tumor undergoing high-dose chemotherapy associated with autologous bone marrow transplantation (ABMT) in the period June 1984-December 1991 and enrolled in the European Bone Marrow Transplantation Registry for Solid Tumors. At diagnosis, 12 children presented stage IV disease, 5 stage III, 3 stage II, and 5 stage I. Before ABMT, 21 children had 1 to 4 relapses (median 1); 13 achieved a second or subsequent complete remission (CR), four stage IV children failed to respond to first line treatment and achieved either CR (3 patients), or partial remission (PR) after second line therapy. At high-dose chemotherapy, 17 children were in CR and 8 had measurable disease. Seven different high-dose regimens were administered, even if 20 children received melphalan mostly associated with vincristine and 8 involved field radiotherapy. Three children died early of pneumonitis; 2 developed an acute transient renal failure, 1 a chronic renal failure. Out of the 8 children with target disease at graft, 2 died of toxicity, 5 achieved CR, 1 obtained PR, and only 1 is presently alive in CCR at 39 months after ABMT. Of the 17 children grafted in CR, 8 are alive event-free at 14-90 months (median 34) from ABMT; 7 relapsed at 3-23 months (median 7 months); 1 died of toxicity and 1 was lost to follow-up in CR at 12 months. A salvage attempt with high-dose chemotherapy in children with resistant or poor prognosis recurrent Wilms' tumor seems to be justified. An international cooperative protocol taking into account the increased risk of lung and renal toxicity is necessary.

Value and difficulties of a common European strategy for recurrent Wilms’ tumor

“…Since the first European Bone Marrow Transplant (EBMT) report [17], the number of WT patients registered in the EBMT registry has grown to nearly 400 cases [Dallorso S, Pers. Comm.…”

Successful double autografts for patients with relapsed clear cell sarcoma of the kidney

“…The European Bone Marrow Transplantation Solid Tumor Registry presented 25 cases with a relapsed Wilms' tumor who received high-dose therapy followed by ABMT. 5 The report included six cases with an unfavorable histology, but their precise histologic types were not shown. Only one case with an unfavorable histology is alive without recurrence at 36 months after ABMT.…”

Effective T cell regeneration following high-dose chemotherapy rescued with CD34+ cell enriched peripheral blood progenitor cells in children

“…1,2 Peripheral blood mononuclear cells (PBMC) that have been stimulated with G-CSF contain a small fraction of haematopoietic CD34 + stem cells 3,4 which are able successfully to restore haematopoiesis after myeloablative HD-CTX. 5,6 The success of such treatment, however, may be hampered by a contamination of the leukapheresis product with residual circulating tumour cells.…”