High-dose chemoradiotherapy supported by marrow infusions for advanced neuroblastoma: A pediatric oncology group study

John Graham Pole, James Casper, Gerald Elfenbein, Adrian Gee, Samuel Gross, William Janssen, Penelope Koch, Robert Marcus, Terry Pick, Jonathan Shuster, Wayne Spruce, Paul Thomas, Andrew M Yeager

Research output: Contribution to journalArticle

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Abstract

We conducted a pilot protocol at seven Pediatric Oncology Group (POG) institutions to examine the feasibility, toxicity, and efficacy of using a common regimen of high-dose chemoradiotherapy (HD CT/RT) supported by autologous or allogeneic marrow infusions in children with metastatic neuroblastoma (NBL) in first or second remission. During a 57-month period, we accrued 101 patients. We report here results for the 81 who completed treatment at least 2 years ago. The HD CT/RT regimen consisted of melphalan 60 mg/m2/d for three doses, and total body irradiation (TBI) either 1.5 Gy (n = 27) or 2.0 Gy (n = 54) twice daily for six doses. Twenty-three patients also received irradiation consisting of 1.2 Gy twice daily for 10 doses to persisting disease sites. Seventy-four were given autologous and seven allogeneic marrow, 64 autologous marrows being purged immunomagnetically. Fifty-four children were in first complete (CR) or partial (PR) remission and 27 in second CR or PR. As of October 1, 1990, follow-up was from 32 to 72 months. Forty-seven of these 81 children relapsed, 10 died of complications, one of unknown cause, and 23 continue in remission, including 21 of the 54 treated in first remission, and 16 who completed treatment more than 3 years ago. The 2-year actuarial event-free survival (EPS) probabilities are first CR (CR1) 32% (SE 10%), first PR (PR1) 43% (SE 9%), second CR (CR2) 33% (SE 27%), and second PR (PR2) 5% (SE 5%). Probability of EFS correlated with remission number (first better than second, P < .001), with interval from diagnosis to HD CT/RT (> 9 months better than < 9 months, P = .055), and with TBI dose (12 Gy better than 9 Gy, P = .031). These encouraging results may partly reflect selection for this treatment of patients with NBL who have a slower disease pace.

Original languageEnglish (US)
Pages (from-to)152-158
Number of pages7
JournalJournal of Clinical Oncology
Volume9
Issue number1
StatePublished - 1991
Externally publishedYes

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Chemoradiotherapy
Neuroblastoma
Whole-Body Irradiation
Bone Marrow
Pediatrics
Melphalan
Patient Selection
Disease-Free Survival
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

High-dose chemoradiotherapy supported by marrow infusions for advanced neuroblastoma : A pediatric oncology group study. / Pole, John Graham; Casper, James; Elfenbein, Gerald; Gee, Adrian; Gross, Samuel; Janssen, William; Koch, Penelope; Marcus, Robert; Pick, Terry; Shuster, Jonathan; Spruce, Wayne; Thomas, Paul; Yeager, Andrew M.

In: Journal of Clinical Oncology, Vol. 9, No. 1, 1991, p. 152-158.

Research output: Contribution to journalArticle

Pole, JG, Casper, J, Elfenbein, G, Gee, A, Gross, S, Janssen, W, Koch, P, Marcus, R, Pick, T, Shuster, J, Spruce, W, Thomas, P & Yeager, AM 1991, 'High-dose chemoradiotherapy supported by marrow infusions for advanced neuroblastoma: A pediatric oncology group study', Journal of Clinical Oncology, vol. 9, no. 1, pp. 152-158.
Pole, John Graham ; Casper, James ; Elfenbein, Gerald ; Gee, Adrian ; Gross, Samuel ; Janssen, William ; Koch, Penelope ; Marcus, Robert ; Pick, Terry ; Shuster, Jonathan ; Spruce, Wayne ; Thomas, Paul ; Yeager, Andrew M. / High-dose chemoradiotherapy supported by marrow infusions for advanced neuroblastoma : A pediatric oncology group study. In: Journal of Clinical Oncology. 1991 ; Vol. 9, No. 1. pp. 152-158.
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AU - Pole, John Graham

AU - Casper, James

AU - Elfenbein, Gerald

AU - Gee, Adrian

AU - Gross, Samuel

AU - Janssen, William

AU - Koch, Penelope

AU - Marcus, Robert

AU - Pick, Terry

AU - Shuster, Jonathan

AU - Spruce, Wayne

AU - Thomas, Paul

AU - Yeager, Andrew M

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