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Possible benefits of high-dose chemotherapy and autologous stem cell transplantation for adults with recurrent medulloblastoma


Al Musella's Comments: (This is his personal views and are not necessarily the views of the Musella Foundation!)



Website: http://www.nature.com/bmt/journal/v30/n9/abs/1703725ab.html

Posted on: 11/12/2002

November (1) 2002, Volume 30, Number 9, Pages 565-569

Possible benefits of high-dose chemotherapy and autologous stem cell transplantation for adults with recurrent medulloblastoma

M I Zia1,2, P Forsyth1,3, A Chaudhry1,4, J Russell1,2,4 and D A Stewart1,2,4

1Department of Oncology, University of Calgary, Calgary, Alberta, Canada

2Department of Medicine, University of Calgary, Calgary, Alberta, Canada

3Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada

4Alberta Blood and Marrow Transplant Program, Tom Baker Cancer Centre, Calgary, Alberta, Canada

Correspondence to: Dr D Stewart, Tom Baker Cancer Centre, 1331-29th Street, NW, Calgary, Alberta, Canada, T2N 4N2

Abstract :
In an attempt to improve the dismal prognosis of adults with recurrent medulloblastoma, six patients were treated with aggressive salvage therapy including high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT). At relapse, all patients underwent surgical debulking followed by HDCT/ASCT and then radiotherapy when possible. The treatment plan included two cycles of HDCT/ASCT; first with cyclophosphamide, etoposide and carboplatin (CECb) and then 2 months later with cyclophosphamide and thiotepa (CT). Three of the six patients received the planned therapy. One patient experienced severe toxicity requiring life-sustaining therapy. This patient developed multi-organ dysfunction including multiple enhancing lesions in both cerebral hemispheres that slowly resolved over several months. Two other patients did not mobilize sufficient stem cells for two ASCT procedures. They received one ASCT conditioned with cyclophosphamide, thiotepa and carboplatin (CTCb). Three of six patients had a complete response (CR); the other three had a partial response (PR). Following the first ASCT, median duration of response was 13.5 months (range 9-29 months) and median survival was 21.5 months (range 12-42 months). There was no treatment-related mortality. We conclude that HDCT/ASCT with CECb-CT or CTCb is active against recurrent medulloblastoma in adults and may be associated with prolonged remissions. Multiple enhancing cerebral lesions on brain MRI early post-HDCT/ASCT may be a consequence of the treatment rather than metastatic disease.

Bone Marrow Transplantation (2002) 30, 565-569. doi:10.1038/sj.bmt.1703725



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