High dose chemotherapy with autologous peripheral blood progenitor cell transplantation in an anephric child with multiply recurrent Wilms tumor

Ramzi Dagher, Susan Kreissman, Kent A. Robertson, Arthur Provisor, Jerry Bergstein, Kay Burke, John H. Rodman, David Emanuel, Franklin O. Smith

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Purpose: An autologous peripheral blood progenitor cell (APBPC) transplant in an anephric child with multiply recurrent Wilms tumor using a conditioning regimen of high dose chemotherapy in conjunction with hemodialysis (HD) and peritoneal dialysis is described. Patient and Methods: The child had a left nephrectomy at 9 months of age for a stage II Wilms tumor. At 6 years of age, she required a right nephrectomy because of progressive, recurrent disease unresponsive to treatment with doxombicin, actinomycin, and vincristine. She was maintained on peritoneal dialysis. Salvage chemotherapy consisted of 5 cycles of carboplatin and cyclophosphamide after APBPCs were collected after granulocyte colony- stimulating factor mobilization. After a preparative regimen of carboplatin, cyclophosphamide, and etoposide with closely timed HD, peripheral blood progenitor cells were infused and peritoneal dialysis was resumed. Results: No nonhematopoietic toxicity occurred. Pharmacokinetic studies demonstrated that HD effectively eliminated carboplatin and provided safe, effective plasma concentrations in this anephric patient. Trilineage engraftment occurred by day +10 and the child was discharged from the hospital on day +14. She had a local recurrence on day +194 and died of progressive disease on day +660. Conclusions: With dialysis support and dose modification, high- dose chemotherapy followed by APBPC transplantation can be successfully performed in the anephric child. Given the lack of organ toxicity in this patient, increased doses of the drugs used in this preparative regimen may be possible for anephric children.

Original languageEnglish (US)
Pages (from-to)357-360
Number of pages4
JournalJournal of Pediatric Hematology/Oncology
Volume20
Issue number4
DOIs
StatePublished - Jul 1 1998

    Fingerprint

Keywords

  • Anephric
  • Autologous peripheral blood progenitor cell transplant
  • Carboplatin pharmacokinetics
  • Wilms tumor

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Hematology

Cite this