Myeloablative chemotherapy with autologous bone marrow rescue in children and adolescents with recurrent malignant astrocytoma: Outcome compared with conventional chemotherapy: A report from the Children's Oncology Group Journal Article
| Authors: | Finlay, J. L.; Dhall, G.; Boyett, J. M.; Dunkel, I. J.; Gardner, S. L.; Goldman, S.; Yates, A. J.; Rosenblum, M. K.; Stanley, P.; Zimmerman, R. A.; Wallace, D.; Pollack, I. F.; Packer, R. J. |
| Article Title: | Myeloablative chemotherapy with autologous bone marrow rescue in children and adolescents with recurrent malignant astrocytoma: Outcome compared with conventional chemotherapy: A report from the Children's Oncology Group |
| Abstract: | Purpose. Children and adolescents with malignant astrocytomas recurring after initial treatment have a dismal prognosis, with only rare patients surviving 1-year beyond recurrence. The purpose of this study was to attempt to improve their survival. Methods. Twenty-seven children and adolescents with malignant astrocytomas [17 glioblastoma multiforme and 10 anaplastic astrocytoma (AA)] following initial tumor progression, received myeloablative chemotherapy followed by autologous marrow rescue with one of three thiotepa and etoposide-based chemotherapy regimens, administered alone (n = 11) or combined with carmustine (n = 5) or carboplatin (n = 11). Time to progression and death following myeloablative chemotherapy for these patients was compared non-randomly with outcome of a contemporaneously treated cohort of similar patients who received only conventional chemotherapy following initial tumor progression. The two cohorts were compared for age, histology, prior therapies, extent of surgical resection at progression, and time from initial diagnosis to progression. Results. Five of 27 children (two with glioblastoma multiforme and three with AA) survive event-free from 8.3 to 13.3 years (median of 11.1 years) following myeloablative chemotherapy. Of 56 children with recurrent malignant astrocytoma who received conventional chemotherapy following initial progression, no patient survives. Differences in distributions of survival were not significant when stratified by surgical debulking (P = 0.39). However, for patients who were surgically debulked, the survival distributions are significantly different (P = 0.017). Conclusions. Myeloablative chemotherapy with autologous marrow rescue can produce durable remissions in children and young adults with recurrent malignant gliomas, in the setting of minimal residual tumor burden achieved surgically. © 2008 Wiley-Liss, Inc. |
| Keywords: | adolescent; adult; cancer chemotherapy; cancer survival; child; controlled study; treatment response; child, preschool; cancer surgery; major clinical study; histopathology; salvage therapy; cisplatin; fluorouracil; cancer combination chemotherapy; cancer growth; monotherapy; cancer radiotherapy; combined modality therapy; brain neoplasms; antineoplastic agent; cytoreductive surgery; carboplatin; neoplasm recurrence, local; etoposide; antineoplastic combined chemotherapy protocols; cohort analysis; cyclophosphamide; cancer mortality; carmustine; ifosfamide; procarbazine; thiotepa; childhood cancer; cranial irradiation; drug fatality; cancer regression; myeloablative conditioning; infant; disease progression; folinic acid; glioblastoma; newborn; intermethod comparison; nitrosourea; platinum derivative; bone marrow transplantation; astrocytoma; mannitol; beta interferon; transplantation, autologous; bone marrow rescue; autologous bone marrow transplantation; perception deafness; myeloablative agonists; myeloablative chemotherapy; autologous bone marrow rescue; recurrent malignant astrocytoma |
| Journal Title: | Pediatric Blood and Cancer |
| Volume: | 51 |
| Issue: | 6 |
| ISSN: | 1545-5009 |
| Publisher: | Wiley Periodicals, Inc |
| Date Published: | 2008-12-01 |
| Start Page: | 806 |
| End Page: | 811 |
| Language: | English |
| DOI: | 10.1002/pbc.21732 |
| PUBMED: | 18802947 |
| PROVIDER: | scopus |
| PMCID: | PMC2844080 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 7" - "Export Date: 17 November 2011" - "CODEN: PBCEA" - "Source: Scopus" |
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