Topotecan, thiotepa, and carboplatin for neuroblastoma: Failure to prevent relapse in the central nervous system Journal Article
| Authors: | Kushner, B. H.; Kramer, K.; Modak, S.; Kernan, N. A.; Reich, L. M.; Danis, K.; Cheung, N. K. V. |
| Article Title: | Topotecan, thiotepa, and carboplatin for neuroblastoma: Failure to prevent relapse in the central nervous system |
| Abstract: | We report on a three-drug myeloablative regimen designed to consolidate remission and to prevent central nervous system (CNS) relapse of high-risk neuroblastoma (NB). Sixty-six NB patients received topotecan 2 mg/m2/day, × 4 days; thiotepa 300 mg/m2/day, × 3 days; and carboplatin ∼500 mg/m2/day, × 3 days. Post-SCT treatments included radiotherapy, immunotherapy, 13-cis-retinoic acid, ±oral etoposide. Significant nonhematologic toxicities were mucositis and skin-related in all patients, convulsions in three patients, and cardiac failure and venocclusive disease of liver in one patient each. Grade 2 hepatotoxicity led to truncating cytoreduction in two patients; both later relapsed in brain. Among 46 patients transplanted in first complete/very good partial remission (CR/VGPR), event-free survival is 54% (s.e.±8%) at 36 months post-SCT; notable events were three non-NB-related deaths (adenovirus on day +9, bowel necrosis at 5 months, multiorgan failure at seven months) and four relapses in brain. Of 12 patients transplanted with evidence of NB, two became long-term event-free survivors and two relapsed in the brain. Of eight patients transplanted in second or greater CR/VGPR, one became a long-term event-free survivor and seven relapsed though not in the CNS. This regimen has manageable toxicity but does not prevent CNS relapse. © 2006 Nature Publishing Group. All rights reserved. |
| Keywords: | adolescent; adult; child; controlled study; treatment outcome; child, preschool; survival rate; treatment failure; major clinical study; cisplatin; doxorubicin; hypertension; skin toxicity; antineoplastic agents; combined modality therapy; topotecan; drug megadose; nuclear magnetic resonance imaging; carboplatin; computer assisted tomography; liver toxicity; neoplasm recurrence, local; etoposide; mucosa inflammation; antineoplastic combined chemotherapy protocols; granulocyte macrophage colony stimulating factor; relapse; cyclophosphamide; vincristine; tumor regression; thiotepa; risk assessment; central nervous system neoplasms; monoclonal antibody; survival time; statistical significance; immunotherapy; neuroblastoma; heart failure; brain metastasis; isotretinoin; granulocyte colony stimulating factor; congestive heart failure; hearing loss; brain metastases; liver venoocclusive disease; convulsion |
| Journal Title: | Bone Marrow Transplantation |
| Volume: | 37 |
| Issue: | 3 |
| ISSN: | 0268-3369 |
| Publisher: | Nature Publishing Group |
| Date Published: | 2006-02-01 |
| Start Page: | 271 |
| End Page: | 276 |
| Language: | English |
| DOI: | 10.1038/sj.bmt.1705253 |
| PUBMED: | 16400336 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 8" - "Export Date: 4 June 2012" - "CODEN: BMTRE" - "Source: Scopus" |
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