High-Dose Chemotherapy with Autologous Hematopoietic Stem-Cell Rescue for Pediatric Brain Tumor Patients : A Single Institution Experience from UCLA

Abstract EN

Background.

Dose-dependent response makes certain pediatric brain tumors appropriate targets for high-dose chemotherapy with autologous hematopoietic stem-cell rescue (HDCT-AHSCR).

Methods.

The clinical outcomes and toxicities were analyzed retrospectively for 18 consecutive patients ≤19 y/o treated with HDCT-AHSCR at UCLA (1999–2009).

Results.

Patients' median age was 2.3 years.

Fourteen had primary and 4 recurrent tumors: 12 neural/embryonal (7 medulloblastomas, 4 primitive neuroectodermal tumors, and a pineoblastoma), 3 glial/mixed, and 3 germ cell tumors.

Eight patients had initial gross-total and seven subtotal resections.

HDCT mostly consisted of carboplatin and/or thiotepa ± etoposide (n=16).

Nine patients underwent a single AHSCR and nine ≥3 tandems.

Three-year progression-free and overall survival probabilities were 60.5% ± 16 and 69.3% ± 11.5.

Ten patients with pre-AHSCR complete remissions were alive/disease-free, whereas 5 of 8 with measurable disease were deceased (median followup: 2.3 yrs).

Nine of 13 survivors avoided radiation.

Single AHSCR regimens had greater toxicity than ≥3 AHSCR (P<.01).

Conclusion.

HDCT-AHSCR has a definitive, though limited role for selected pediatric brain tumors with poor prognosis and pretransplant complete/partial remissions.