HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS BLOOD STEM-CELL TRANSPLANTATIONIN CHILDREN WITH METASTATIC NEUROBLASTOMA

High-dose chemotherapy (HDC) followed by autologous blood stem cell tr ansplantation (ABSCT) was performed to improve the prognosis of childr en with metastatic neuroblastoma over 1 year of age at diagnosis. Seve n stage IV neuroblastoma patients with a median age of 3.9 years (rang e 1.6-11.4 years) received conventional chemotherapy before leukaphere sis for ABSCT. The median duration of chemotherapy before harvest was 8 months (range 3-23 months). Peripheral blood stem cells (PBSC) were harvested from them after the use of cytotoxic drugs plus granulocyte colony-stimulating factor. The median number of granulocyte-macrophage colony forming units collected after harvest was 23.2 x 10(4)/kg (ran ge 10.1-45.3 x 10(4)/kg). The patients were administered HDC consistin g of carboplatin, etoposide, and melphalan followed by ABSCT. Hematopo ietic reconstitution after ABSCT was favorable; recovery of granulocyt es count > 0.5 x 10(9)/L occurred within 2 weeks and stable platelet e ngraftment occurred at a median duration of 23 days (range 7-33 days). The toxicity of ABSCT was well tolerable. Two of the four patients wh o received ABSCT at their first complete remission remained in remissi on 67 and 68 months after ABSCT. One with partial remission also showe d a good response for 8 months. The other two at first relapse showed a transient regression of the tumor. The prognosis of seven patients w ho received ABSCT was significantly better than that of 13 patients wh o received conventional therapy alone. These findings suggest that HDC followed by ABSCT is safe and useful as consolidation therapy for the treatment of patients with metastatic neuroblastoma.