J Korean Med Sci.  2010 May;25(5):691-697. 10.3346/jkms.2010.25.5.691.

Efficacy of Tandem High-Dose Chemotherapy and Autologous Stem Cell Rescue in Patients Over 1 Year of Age with Stage 4 Neuroblastoma: The Korean Society of Pediatric Hematology-Oncology Experience Over 6 Years (2000-2005)

• Sung KW
• Ahn HS
• Cho B
• Choi YM
• Chung NG
• Hwang TJ
• Im HJ
• Jeong DC
• Kang HJ
• Koo HH
• Kook H
• Kim HK
• Lyu CJ
• Seo JJ
• Shin HY
• Yoo KH
• Won SC
• Lee KS

• KMID: 1713951
• DOI: http://doi.org/10.3346/jkms.2010.25.5.691

Abstract

The efficacy of tandem high-dose chemotherapy and autologous stem cell rescue (HDCT/ASCR) was investigated in patients with high-risk neuroblastoma. Patients over 1 yr of age who were newly diagnosed with stage 4 neuroblastoma from January 2000 to December 2005 were enrolled in The Korean Society of Pediatric Hematology-Oncology registry. All patients who were assigned to receive HDCT/ASCR at diagnosis were retrospectively analyzed to investigate the efficacy of single or tandem HDCT/ASCR. Seventy and 71 patients were assigned to receive single or tandem HDCT/ASCR at diagnosis. Fifty-seven and 59 patients in the single or tandem HDCT group underwent single or tandem HDCT/ASCR as scheduled. Twenty-four and 38 patients in the single or tandem HDCT group remained event free with a median follow-up of 56 (24-88) months. When the survival rate was analyzed according to intent-to-treat at diagnosis, the probability of the 5-yr event-free survival+/-95% confidence intervals was higher in the tandem HDCT group than in the single HDCT group (51.2+/-12.4% vs. 31.3+/-11.5%, P=0.030). The results of the present study demonstrate that the tandem HDCT/ASCR strategy is significantly better than the single HDCT/ASCR strategy for improved survival in the treatment of high-risk neuroblastoma patients.

Keyword

Neuroblastoma; High-dose Chemotherapy; Transplantation, Autologous

MeSH Terms

Adolescent
Child
Child, Preschool
Combined Modality Therapy/mortality
Drug Therapy/*mortality
Female
Humans
Infant
Korea/epidemiology
Longitudinal Studies
Male
Neuroblastoma/*mortality/*therapy
Prevalence
Risk Assessment/methods
Risk Factors
Stem Cell Transplantation/*mortality
Survival Analysis
Survival Rate
Treatment Outcome

Figure

• 

  Fig. 1 Flow of patients. Fifty-seven (81.4%) out of 70 patients in the single group proceeded to the HDCT/ASCR as assigned at diagnosis. In the tandem group, 66 (93.0%) out of 71 patients proceeded to the first HDCT/ASCR and 59 (83.1%) patients received the second HDCT/ASCR as assigned at diagnosis.

• 

  Fig. 2 Results of the Kaplan-Meier analysis. (A) When the survival rate was analyzed according to intent-to-treat at diagnosis, the probability of the 5-yr EFS after diagnosis was higher in the tandem group than in the single group (51.2±12.4% vs. 31.3±11.5%, P=0.030). (B) When the analysis was confined to 123 patients who proceeded to HDCT/ASCR as assigned at diagnosis, the probability of 5-yr RFS after the first HDCT was higher in the tandem group than in the single group with borderline significance (59.7±13.5% vs. 41.6±14.5%, P=0.099). (C) However, the difference became significant when the analysis was confined to only patients who were not in CR prior to the first HDCT (55.7±17.0% vs. 0%, P=0.012).

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