J Korean Med Sci.  2015 Aug;30(8):1062-1067. 10.3346/jkms.2015.30.8.1062.

Clinical Significance of Persistent Tumor in Bone Marrow during Treatment of High-risk Neuroblastoma

• Choi YB
• Bae GE
• Lee NH
• Kim JS
• Lee SH
• Yoo KH
• Sung KW
• Koo HH

• KMID: 2164500
• DOI: http://doi.org/10.3346/jkms.2015.30.8.1062

Abstract

The records of 63 high-risk neuroblastoma patients with bone marrow (BM) tumors at diagnosis were retrospectively reviewed. All patients received nine cycles of induction chemotherapy followed by tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT). Follow-up BM examination was performed every three cycles during induction chemotherapy and every three months for one year after the second HDCT/auto-SCT. BM tumor cells persisted in 48.4%, 37.7%, 23.3%, and 20.4% of patients after three, six, and nine cycles of induction chemotherapy and three months after the second HDCT/auto-SCT, respectively. There was no difference in progression-free survival (PFS) rate between patients with persistent BM tumor and those without during the induction treatment. However, after tandem HDCT/auto-SCT, the PFS rate was worse in patients with persistent BM tumor than in those without (probability of 5-yr PFS 14.7% +/- 13.4% vs. 64.2% +/- 8.3%, P = 0.009). Persistent BM tumor during induction treatment is not associated with a worse prognosis when intensive tandem HDCT/auto-SCT is given as consolidation treatment. However, persistent BM tumor after tandem HDCT/auto-SCT is associated with a worse prognosis. Therefore, further treatment might be needed in patients with persistent BM tumor after tandem HDCT/auto-SCT.

Keyword

Neuroblastoma; Bone Marrow Tumors; Prognosis; Treatment

MeSH Terms

Adolescent
Antineoplastic Combined Chemotherapy Protocols/administration & dosage
Bone Marrow Neoplasms/pathology/*secondary/*therapy
Child
Child, Preschool
Combined Modality Therapy/methods
Female
Humans
Induction Chemotherapy/methods
Infant
Infant, Newborn
Male
Neoplasms, Multiple Primary/pathology/*therapy
Neuroblastoma/*pathology/*therapy
Prognosis
Retrospective Studies
Risk Factors
Stem Cell Transplantation/*methods
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 Results of bone marrow examination. (A) Proportion of patients with persistent BM tumor gradually decreases during follow-up. (B) In patients with persistent BM tumor, tumor area in BM decreases significantly during the first three cycles of chemotherapy (Dx-C3); however, it does not change during further follow-up (C3-T3). Proportions of ganglion cell (C) and Schwannian stroma (D) gradually increase during treatment and follow-up.

• 

  Fig. 2 PFS according to presence/absence of persistent BM tumor. There was no difference in progression free survival (PFS) rates between patients with persistent BM involvement (BMI) of tumor and those without at three (A), six (B), and nine (C) cycles of induction chemotherapy. (D) However, the PFS rate in patients with BMI of tumor was worse than those without at three months after tandem HDCT/auto-SCT.

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