Allogeneic and autologous stem-cell transplantation in advanced Ewing tumors - An update after long-term follow-up from two centers of the European Intergroup Study EICESS

Background: An update of results from the High Risk Protocol of the Meta-EI CESS Study, conducted at the Pediatric Stem-Cell Transplant Centers of Duss eldorf and Vienna. In order to evaluate a possible therapeutic benefit afte r allogeneic SCT in patients with advanced Ewing tumors (AET), we compared outcome after autologous and allogeneic stem-cell transplantation (SCT). Patients and methods: We analyzed 36 patients treated with the myeloablativ e Hyper-ME protocol (hyperfractionated total body irradiation, melphalan, e toposide +/- carboplatin) between November 1986 and December 1994. Minimal follow-up for all patients was five years. All patients underwent remission induction chemotherapy and local treatment before myeloablative therapy. S eventeen of thirty-six patients had multifocal primary Ewing's tumor, eight een of thirty-six had early, multiple or multifocal relapse, one of thirty- six patients had unifocal late relapse. Twenty-six of thirty-six were treat ed with autologous and ten of thirty-six with allogeneic hematopoetic stem cells. We analyzed the following risk factors, that could possibly influenc e the event-free survival (EFS): number of involved bones, degree of remiss ion at time of SCT, type of graft, indication for SCT, bone marrow infiltra tion, bone with concomitant lung disease, age at time of diagnosis, pelvic involvement, involved compartment radiation, histopathological diagnosis. Results: EFS for the 36 patients was 0.24 (0.21) +/- 0.07. Eighteen of thir ty-six patients suffered relapse or died of disease, nine of thirty-six die d of treatment related toxicity (DOC). Nine of thirty-six patients are aliv e in CR. Age greater than or equal to 17 years at initial diagnosis (P < 0. 005) significantly deteriorated outcome. According to the type of graft, EF S was 0.25 +/- 0.08 after autologous and 0.20 +/- 0.13 after allogeneic SCT . Incidence of DOC was more than twice as high after allogeneic (40%) compa red to autologous (19%) SCT, even though the difference did not reach signi ficance (P = 0.08, Fisher's exact test). Conclusions: Because of the rather short observation period, secondary mali gnant neoplasm (SMN) may complicate the future clinical course of some of o ur patients who are currently viewed as event-free survivors. EFS in AET is not improved by allogeneic SCT due to a higher complication rate. The pati ent group was to small to analyze for a possible graft-versus-tumor effect.