AUTOLOGOUS PERIPHERAL-BLOOD CELL TRANSPLANTATION IN THE TREATMENT OF ADVANCED NEUROBLASTOMA

Purpose: We review the experience with autologous peripheral blood cel l transplantation (APBCT) in children with neuroblastoma at the Univer sity of Minnesota. Patients and Methods: Aspects of peripheral blood c ell collection and use in nine patients who had advanced neuroblastoma (eight Evans stage IV, I stage III), who were median age 4 years (ran ge 10 months-22 years, and who were treated with high-dose chemotherap y without total body irradiation and APBCT between September 1987 and December 1989 are reviewed. Results: A median of 4.8 x 10(9) (range 3. 3-8.9) mononuclear cells per kilogram of body weight were obtained by a median of six (range four-eight) collections. In vitro assay of gran ulocyte-monocyte colony-forming cells (CFU-GM) demonstrated a median o f 3.6 x 10(4) (range 0.7-7.8) CFU-GM/kg of body weight. After APBCT, g ranulocyte recovery (absolute neutrophil count >500 x 10(6)/L) occurre d at a median of 28 days (range 14-72) and platelet recovery (>150 x 1 0(9)/L) occurred at a median of 34 days (range 19-202). All patients b ut one, who had progressive disease, were transplanted with residual d isease. Immunocytological analysis of peripheral blood stem cell harve st showed the presence of circulating neuroblastoma cells in three of nine patients, all of whom had minimal marrow residual disease by biop sy. One patient is still alive with no evidence of disease after 5 yea rs. The others died of recurrent neuroblastoma a median of 14 months ( range 3-29) after transplant. Conclusion: APBCT is safe and effective for hematopoietic reconstitution after high-dose chemotherapy, and may be useful when a bone marrow harvest cannot be performed because of p rior pelvic radiation or minimal residual bone marrow metastasis. Immu nocytological methods to ensure that the product is free of tumor cont amination should be performed.