Kk. Matthay et al., ROLE OF MYELOABLATIVE THERAPY IN IMPROVED OUTCOME FOR HIGH-RISK NEUROBLASTOMA - REVIEW OF RECENT CHILDRENS CANCER GROUP RESULTS, European journal of cancer, 31A(4), 1995, pp. 572-575
The use of new strategies for dose intensification using peripheral bl
ood stem cell or autologous purged bone marrow rescue has raised expec
tations for cure in advanced neuroblastoma, although conflicting repor
ts exist regarding the efficacy of these approaches. Using risk groups
based on both biological and clinical staging, the Children's Cancer
Group (CCG) has conducted a series of pilot studies to test new induct
ion, consolidation and myeloablative regimens to attempt to improve ou
tcome. We summarise below the outcome and prognostic factor analysis f
or the pilot chemotherapy trial, CCG-(CCG-321P2), and the use of high
dose myeloablative chemoradiotherapy with allogeneic (CCG-321P1) or au
tologous purged bone marrow rescue (CCG-321P3) for high risk neuroblas
toma patients who were progression-free at the end of induction chemot
herapy. After autologous bone marrow transplantation (ABMT), progressi
on-free survival (PFS) at 4 years was 38% (median follow-up 4 years).
Prognostic factors for relapse after ABMT included pre-BMT disease sta
tus, bone marrow tumour content at harvest, extent of primary resectio
n at diagnosis, and time to ABMT. MYCN amplification, age, stage, and
pre-BMT myeloablative regimen were not significant. Allogeneic BMT did
not have a better outcome than ABMT. In a retrospective, non-randomis
ed comparison of ABMT and chemotherapy, there was a significant differ
ence in PFS for stage IV patients. High risk subgroups possibly benefi
ting from ABMT could be identified, including those with tumour MYCN a
mplification, over 2 years at diagnosis, and those not in complete rem
ission at the end of induction. A randomised prospective trial compari
ng myeloablative therapy with ABMT to continuous infusion consolidatio
n chemotherapy is currently underway in CCG to determine the relative
benefit.