Tandem autologous peripheral blood stem cell transplantation for neuroblastoma
Neuroblastoma is a cancer that arises in immature nerve cells and primarily affects infants and children. Approximately 70% of patients with neuroblastoma have metastatic disease at diagnosis. Although some progress has been made in the treatment of this disease over the past 40 years, fewer than 35% of high-risk patients will survive for 5 years without recurrence. The current standard therapy for high-risk neuroblastoma is based on a regimen of multicycle, multiagent induction chemotherapy; autologous peripheral blood stem cell (PBSC) collection early in induction; testing of the PBSC product for neuroblastoma contamination; organ-sparing surgical resection of primary tumor; consolidation therapy with high-dose chemotherapy (HDC) and single autologous PBSC rescue (PBSCR); local radiation therapy before or after the autologous PBSCR, sometimes followed by total body irradiation (TBI); biologic treatment with 13-cis-retinoic acid (CRA); and immunotherapy with antidisialoganglioside (anti-GD2) antibody. The introduction of autologous PBSC has allowed for dose escalation of effective anti-neuroblastoma agents beyond marrow suppression, significantly improving the outcome when compared with conventional chemotherapy alone. However, the overall event-free survival (EFS) remained less than 30% to 40%. In this context, some investigators examined the effectiveness of further intensifying consolidation therapy with tandem HDC and PBSCR to improve the outcome in high-risk neuroblastoma patients.
- Peripheral Blood Stem Cell Transplantation
- Transplantation, Autologous