28 years of high-dose therapy and SCT for neuroblastoma in Europe: lessons from more than 4000 procedures
BONE MARROW TRANSPLANTATION, cilt.41, 2008 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 41
- Basım Tarihi: 2008
- Doi Numarası: 10.1038/bmt.2008.69
- Dergi Adı: BONE MARROW TRANSPLANTATION
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Anahtar Kelimeler: neuroblastoma, high-dose treatment, stem cells, EBMT, BONE-MARROW-TRANSPLANTATION, HIGH-RISK NEUROBLASTOMA, STEM-CELL TRANSPLANTATION, CHIMERIC ANTI-GD2-ANTIBODY CH14.18, COLONY-STIMULATING FACTOR, STAGE-IV NEUROBLASTOMA, TOTAL-BODY IRRADIATION, PERIPHERAL-BLOOD, I-131 METAIODOBENZYLGUANIDINE, METASTATIC NEUROBLASTOMA
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Ankara Üniversitesi Adresli: Evet
Özet
Between 1978 and 2006, the European Group for Blood and Marrow Transplantation registered 4098 high-dose therapy (HDT) procedures followed by stem cell rescue (SCR) (3974 autologous/124 allogeneic) in patients with neuroblastoma. The 5-year rates for overall (OS) and event-free survival are 37 and 32%, respectively. The median age at diagnosis is 3.9 years (0.3-62 years) with 76 patients older than 18 years. Patients above 10 years carry a 2.5-fold higher risk. Younger patients cure significantly (< 0.001) better with OS rates of 40 and 30% for age groups 2-4 years and 4-10 years, respectively. Their risks are about twofold higher than that of patients below 2 years with OS rates of 60%. The better the quality of remission status before HDT/SCT the better are the observed OS rates: 43% in CR1 (1199 patients) and 42% for CR2 (140 patients), and 36% for those in very good partial or partial remission (1413 patients) and 21% for those with sensitive relapse (134 patients). Patients reported with stable disease in first remission still had an OS rate of 30%. Multivariate analysis shows significantly better OS in the age group of less than 2 years (< 0.0001), as well as a better quality of remission status before HDT/SCT (P < 0.0001), with the use of peripheral stem cells (P = 0.014), autologous SCT (P = 0.031) and busulphan/melphalan HDT (P < 0.001). Busulphan/melphalan HDT/SCT in first remission achieves an OS of 48%, while it is only 35% with other regimens (P < 0.001), including melphalan alone, other melphalan-containing regimens, a variety of other drugs given as a single HDT as well as the addition of TBI or sequential HDT/SCT procedures. Further progress in the field may only be expected from large-scale international randomized trials.