Intensive induction chemotherapy followed by myeloablative chemotherapy with autologous hematopoietic progenitor cell rescue for young children newly‐diagnosed with central nervous system atypical teratoid/rhabdoid tumors: The head start III experience

Abstract

A minority of children with CNS AT/RT treated on HS III may be long-term survivors without irradiation. More effective therapies are desperately needed.

Decreased morbidity and mortality of autologous hematopoietic transplants for children with malignant central nervous system tumors: the ‘Head Start’ trials, 1991–2009

“…[13][14][15][16][17][18][19][20][21][22] The basic treatment schema consisted of five 21-to 28-day cycles of induction chemotherapy: cisplatin (3.5 mg/kg) on day 0, vincristine (0.05 mg/kg) on days 0, 8 and 15, cyclophosphamide (65 mg/kg) on days 1 and 2 and etoposide (4 mg/kg) on days 1 and 2 (Regimen A, HS I) with the addition of high-dose methotrexate (400 mg/kg) on day 3 for metastatic patients (HS II Regimen A2), or with two cycles replacing cisplatin and methotrexate by oral etoposide (1.67 mg/kg/day) on days 1-10 and oral temozolomide (6.5 mg/kg/day) on days 1-5 (HS III Regimen D or D2). During HS III, Regimen D was modified due to toxicities by reduction of cyclophosphamide to 55 mg/kg/day and methotrexate to 320 mg/kg.…”

“…These trials sought to improve patients' cure rate and quality of survival through avoidance or reduction of CNS irradiation by utilizing a single cycle of marrow-ablative chemotherapy with autologous hematopoietic rescue as consolidation following initial induction chemotherapy. [13][14][15][16][17][18][19][20][21][22] The goal of this present study was to examine changes in the rate of serious toxicities (grades III-V) associated with AuHCR in the first 100 days following transplant over the course of the 'Head Start' trials from 1991 to 2009.…”

A case of relapsing spinal atypical teratoid/rhabdoid tumor (AT/RT) responding to vinorelbine, cyclophosphamide, and celecoxib

“…Because of its rapid progression and its severe prognosis, front-line multimodal intensive treatment is the widest adopted therapeutic option [3,[6][7][8]. Recent and most successful studies consist, after surgery, with the goal of achieving gross tumor resection, intensive systemic and intrathecal chemotherapy, followed by highdose chemotherapy (HDCT) with autologous hemopoietic stem cells rescue [3,[6][7][8], and radiotherapy. The role of HDCT is still unclear because limited data are available.…”

“…The prognosis for patients with AT/RT is poor, with a mean overall survival less than 1 year [3]. Patients younger than 2 years or with metastatic disease at diagnosis carry a dismal prognosis, while patients presenting with older age, localized disease, and adequate surgery share a better outcome [5,6].…”

“…This therapeutic approach consists in the frequent administration of lower doses of chemotherapy that reduces drug toxicity [6,10]. By targeting endothelial cells, LDM chemotherapy determined an antiangiogenic effect, resulting in inhibition of tumor progression.…”