Gb. Mccowage et al., AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR ADVANCED NEUROBLASTOMA USING TENIPOSIDE, DOXORUBICIN, MELPHALAN, CISPLATIN, AND TOTAL-BODY IRRADIATION, Journal of clinical oncology, 13(11), 1995, pp. 2789-2795
Background: Disseminated neuroblastoma after infancy hers a dismal pro
gnosis; rang-term survival with conventional therapy occurs in approxi
mately 10% of cases. Patients and Methods: Between 1985 and 1992, we f
ollowed strategy aimed to achieve remission with an induction combinat
ion of intensive chemotherapy, primary resection, and tumor-bed radiot
herapy (TBRT). Patients who achieved remission proceeded to myeloablat
ive chemoradiotherapy and unpurged autologous bone marrow transplant (
ABMT). Twenty-eight patients older than 1 year presented with stage IV
disease during the study period; six died of progressive disease and
three died of complications of therapy. Nineteen patients achieved rem
ission, two of whom did not receive ABMT. Seventeen patients proceeded
to ABMT. Conditioning was with teniposide 130 mg/m(2), doxorubicin 30
mg/m(2), melphalan 120 mg/m(2), cisplatin 80 mg/m(2), and total-body
irradiation 12 Gy in six fractions (modified VAMP-TBI). Results: Princ
ipal nonhematologic toxicities were mucositis and diarrhea, There were
no ABMT-related deaths. Two patients relapsed at 8 and 26 months post
-ABMT, respectively. Fifteen patients remain in complete remission (CR
) at 24 to 102 months (median, 71) from ABMT and 30 to 114 months (med
ian, 78) from diagnosis, Survival rates of all 28 patients are 61% and
50% at 2 and 5 years, respectively, and the disease-free survival (DF
S) of the ABMT group is 94% and 87% at 2 and 5 years, respectively. Co
nclusion: Modified VAMP-TBI appears to be an effective conditioning re
gimen, with 15 of 17 patients remaining disease-free, with no toxic de
aths. This result compares favorably with that of other groups, Larger
numbers of patients need to be treated to confirm the efficacy of thi
s therapy. (C) 1995 by American Society of Clinical Oncology.