HIGH-DOSE CHEMOTHERAPY WITH AUTOLOGOUS PERIPHERAL-BLOOD PROGENITOR-CELL TRANSPLANTATION IN AN ANEPHRIC CHILD WITH MULTIPLY RECURRENT WILMS-TUMOR

Purpose: An autologous peripheral blood progenitor cell (APBPC) transp lant in an anephric child with multiply recurrent Wilms tumor using a conditioning regimen of high dose chemotherapy in conjunction with hem odialysis (HD) and peritoneal dialysis is described. Patient and Metho ds: The child had a left nephrectomy at 9 months of age for a stage II Wilms tumor. At 6 years of age, she required a right nephrectomy beca use of progressive, recurrent disease unresponsive to treatment with d oxorubicin, actinomycin, and vincristine. She was maintained on perito neal dialysis. Salvage chemotherapy consisted of 5 cycles of carboplat in and cyclophosphamide after APBPCs were collected after granulocyte colony-stimulating factor mobilization. After a preparative regimen of carboplatin, cyclophosphamide, and etoposide with closely timed HD, p eripheral blood progenitor cells were infused and peritoneal dialysis was resumed. Results: No nonhematopoietic toxicity occurred. Pharmacok inetic studies demonstrated that HD effectively eliminated carboplatin and provided safe, effective plasma concentrations in this anephric p atient. Trilineage engraftment occurred by day +10 and the child was d ischarged from the hospital on day +14. She had a local recurrence on day +194 and died of progressive disease on day +660.Conclusions: With dialysis support and dose modification, high-dose chemotherapy follow ed by APBPC transplantation can be successfully performed in the aneph ric child. Given the lack of organ toxicity in this patient, increased doses of the drugs used in this preparative regimen may be possible f or anephric children.