Treatment of relapsed Wilms' tumor with high-dose therapy and autologous hematopoietic stem-cell rescue

The experience at children's memorial hospital

Andrew D. Campbell, Susan L. Cohn, Marleta Reynolds, Roopa Seshadri, Elaine Morgan, Grant Geissler, Alfred Rademaker, Maryann Marymount, John Kalapurakal, Paul Haut, Reggie Duerst, Morris Kletzel

Research output: Contribution to journalArticle

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Abstract

Purpose: To investigate whether high-dose therapy with hematopoietic stem-cell rescue (HSCR) will improve survival for patients with relapsed Wilms' tumor. Patients and Methods: Thirteen children with relapsed Wilms' tumor were treated with one or two cycles of high-dose chemotherapy (HDT) followed by autologous HSCR. Twelve of 13 patients received reinduction chemotherapy before HDT and HSCR. The median age at diagnosis was 4.8 years, and the median time to relapse was 12 months. The histology was favorable in 12 of 13 patients. The ablative regimens included: (1) thiotepa (TT)/cyclophosphamide (CTX)/carboplatin (CP; n = 2); (2) TT/CTX (n = 5); (3) TT/etoposide (ETP; n = 1); and (4) CP/ETP/CTX (n = 1). Four patients received two cycles of HDT and HSCR. Cycle 1 consisted of CP/ETP/CTX, and melphalan/CTX were used in cycle 2. Results: Seven of 13 patients are alive without evidence of disease, with a median follow-up of 30 months. The 4-year estimated event-free survival (EFS) rate is 60% (95% CI, 0.40 to 6.88), and the overall survival (OS) at 4 years is 73% (95% CI, 0.40 to 6.86). There was no transplant-related mortality. All patients engrafted to an absolute neutrophil count 500/μL at a median of 13 days (range, 8 to 62 days) and had an unsustained platelet count > 20.0μ at a median of 16 days (range, 10 to 202 days). Conclusion: Our results suggest that HDT with HSCR is an effective treatment for patients with Wilms' tumor who experience relapse.

Original languageEnglish (US)
Pages (from-to)2885-2890
Number of pages6
JournalJournal of Clinical Oncology
Volume22
Issue number14
DOIs
StatePublished - 2004

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Wilms Tumor
Hematopoietic Stem Cells
Thiotepa
Drug Therapy
Therapeutics
Recurrence
Melphalan
Survival
Carboplatin
Etoposide
Platelet Count
Cyclophosphamide
Disease-Free Survival
Histology
Neutrophils
Survival Rate
Transplants
Mortality

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Treatment of relapsed Wilms' tumor with high-dose therapy and autologous hematopoietic stem-cell rescue : The experience at children's memorial hospital. / Campbell, Andrew D.; Cohn, Susan L.; Reynolds, Marleta; Seshadri, Roopa; Morgan, Elaine; Geissler, Grant; Rademaker, Alfred; Marymount, Maryann; Kalapurakal, John; Haut, Paul; Duerst, Reggie; Kletzel, Morris.

In: Journal of Clinical Oncology, Vol. 22, No. 14, 2004, p. 2885-2890.

Research output: Contribution to journalArticle

Campbell, AD, Cohn, SL, Reynolds, M, Seshadri, R, Morgan, E, Geissler, G, Rademaker, A, Marymount, M, Kalapurakal, J, Haut, P, Duerst, R & Kletzel, M 2004, 'Treatment of relapsed Wilms' tumor with high-dose therapy and autologous hematopoietic stem-cell rescue: The experience at children's memorial hospital', Journal of Clinical Oncology, vol. 22, no. 14, pp. 2885-2890. https://doi.org/10.1200/JCO.2004.09.073
Campbell, Andrew D. ; Cohn, Susan L. ; Reynolds, Marleta ; Seshadri, Roopa ; Morgan, Elaine ; Geissler, Grant ; Rademaker, Alfred ; Marymount, Maryann ; Kalapurakal, John ; Haut, Paul ; Duerst, Reggie ; Kletzel, Morris. / Treatment of relapsed Wilms' tumor with high-dose therapy and autologous hematopoietic stem-cell rescue : The experience at children's memorial hospital. In: Journal of Clinical Oncology. 2004 ; Vol. 22, No. 14. pp. 2885-2890.
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abstract = "Purpose: To investigate whether high-dose therapy with hematopoietic stem-cell rescue (HSCR) will improve survival for patients with relapsed Wilms' tumor. Patients and Methods: Thirteen children with relapsed Wilms' tumor were treated with one or two cycles of high-dose chemotherapy (HDT) followed by autologous HSCR. Twelve of 13 patients received reinduction chemotherapy before HDT and HSCR. The median age at diagnosis was 4.8 years, and the median time to relapse was 12 months. The histology was favorable in 12 of 13 patients. The ablative regimens included: (1) thiotepa (TT)/cyclophosphamide (CTX)/carboplatin (CP; n = 2); (2) TT/CTX (n = 5); (3) TT/etoposide (ETP; n = 1); and (4) CP/ETP/CTX (n = 1). Four patients received two cycles of HDT and HSCR. Cycle 1 consisted of CP/ETP/CTX, and melphalan/CTX were used in cycle 2. Results: Seven of 13 patients are alive without evidence of disease, with a median follow-up of 30 months. The 4-year estimated event-free survival (EFS) rate is 60{\%} (95{\%} CI, 0.40 to 6.88), and the overall survival (OS) at 4 years is 73{\%} (95{\%} CI, 0.40 to 6.86). There was no transplant-related mortality. All patients engrafted to an absolute neutrophil count 500/μL at a median of 13 days (range, 8 to 62 days) and had an unsustained platelet count > 20.0μ at a median of 16 days (range, 10 to 202 days). Conclusion: Our results suggest that HDT with HSCR is an effective treatment for patients with Wilms' tumor who experience relapse.",
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T2 - The experience at children's memorial hospital

AU - Campbell, Andrew D.

AU - Cohn, Susan L.

AU - Reynolds, Marleta

AU - Seshadri, Roopa

AU - Morgan, Elaine

AU - Geissler, Grant

AU - Rademaker, Alfred

AU - Marymount, Maryann

AU - Kalapurakal, John

AU - Haut, Paul

AU - Duerst, Reggie

AU - Kletzel, Morris

PY - 2004

Y1 - 2004

N2 - Purpose: To investigate whether high-dose therapy with hematopoietic stem-cell rescue (HSCR) will improve survival for patients with relapsed Wilms' tumor. Patients and Methods: Thirteen children with relapsed Wilms' tumor were treated with one or two cycles of high-dose chemotherapy (HDT) followed by autologous HSCR. Twelve of 13 patients received reinduction chemotherapy before HDT and HSCR. The median age at diagnosis was 4.8 years, and the median time to relapse was 12 months. The histology was favorable in 12 of 13 patients. The ablative regimens included: (1) thiotepa (TT)/cyclophosphamide (CTX)/carboplatin (CP; n = 2); (2) TT/CTX (n = 5); (3) TT/etoposide (ETP; n = 1); and (4) CP/ETP/CTX (n = 1). Four patients received two cycles of HDT and HSCR. Cycle 1 consisted of CP/ETP/CTX, and melphalan/CTX were used in cycle 2. Results: Seven of 13 patients are alive without evidence of disease, with a median follow-up of 30 months. The 4-year estimated event-free survival (EFS) rate is 60% (95% CI, 0.40 to 6.88), and the overall survival (OS) at 4 years is 73% (95% CI, 0.40 to 6.86). There was no transplant-related mortality. All patients engrafted to an absolute neutrophil count 500/μL at a median of 13 days (range, 8 to 62 days) and had an unsustained platelet count > 20.0μ at a median of 16 days (range, 10 to 202 days). Conclusion: Our results suggest that HDT with HSCR is an effective treatment for patients with Wilms' tumor who experience relapse.

AB - Purpose: To investigate whether high-dose therapy with hematopoietic stem-cell rescue (HSCR) will improve survival for patients with relapsed Wilms' tumor. Patients and Methods: Thirteen children with relapsed Wilms' tumor were treated with one or two cycles of high-dose chemotherapy (HDT) followed by autologous HSCR. Twelve of 13 patients received reinduction chemotherapy before HDT and HSCR. The median age at diagnosis was 4.8 years, and the median time to relapse was 12 months. The histology was favorable in 12 of 13 patients. The ablative regimens included: (1) thiotepa (TT)/cyclophosphamide (CTX)/carboplatin (CP; n = 2); (2) TT/CTX (n = 5); (3) TT/etoposide (ETP; n = 1); and (4) CP/ETP/CTX (n = 1). Four patients received two cycles of HDT and HSCR. Cycle 1 consisted of CP/ETP/CTX, and melphalan/CTX were used in cycle 2. Results: Seven of 13 patients are alive without evidence of disease, with a median follow-up of 30 months. The 4-year estimated event-free survival (EFS) rate is 60% (95% CI, 0.40 to 6.88), and the overall survival (OS) at 4 years is 73% (95% CI, 0.40 to 6.86). There was no transplant-related mortality. All patients engrafted to an absolute neutrophil count 500/μL at a median of 13 days (range, 8 to 62 days) and had an unsustained platelet count > 20.0μ at a median of 16 days (range, 10 to 202 days). Conclusion: Our results suggest that HDT with HSCR is an effective treatment for patients with Wilms' tumor who experience relapse.

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