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Efficacy of high-dose chemotherapy and autologous stem cell transplantation in patients with relapsed medulloblastoma: a report on the Korean Society for Pediatric Neuro-Oncology (KSPNO)-S-053 study.

Park JE, Kang J, Yoo KH, Sung KW, Koo HH, Lim do H, Shin HJ, Kang HJ, Park KD, Shin HY, Kim IH, Cho BK, Im HJ, Seo JJ, Park HJ, Park BK, Ahn HS - J. Korean Med. Sci. (2010)

Bottom Line: The 3-yr overall survival probability and event-free survival rates +/-95% confidence intervals (CI) were 33.3+/-12.2% and 26.7% +/-11.4%, respectively.When analysis was confined to only patients who had a complete response (CR) or partial response (PR) prior to HDCT, the probability of 3-yr overall survival rates +/-95% CI was 40.0+/-15.5%.No patients with stable disease (SD) or progressive disease (PD) survived.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT
The efficacy and toxicity of high-dose chemotherapy and autologous stem cell transplantation (HDCT/ASCT) were investigated for improving the outcomes of patients with relapsed medulloblastoma. A total of 15 patients with relapsed medulloblastoma were enrolled in the KSPNO-S-053 study from May 2005 to May 2007. All patients received approximately 4 cycles of salvage chemotherapy after relapse. Thirteen underwent HDCT/ASCT; CTE and CM regimen were employed for the first HDCT (HDCT1) and second HDCT (HDCT2), respectively, and 7 underwent HDCT2. One transplant related mortality (TRM) due to veno-occlusive disease (VOD) occurred during HDCT1 but HDCT2 was tolerable with no further TRM. The 3-yr overall survival probability and event-free survival rates +/-95% confidence intervals (CI) were 33.3+/-12.2% and 26.7% +/-11.4%, respectively. When analysis was confined to only patients who had a complete response (CR) or partial response (PR) prior to HDCT, the probability of 3-yr overall survival rates +/-95% CI was 40.0+/-15.5%. No patients with stable disease (SD) or progressive disease (PD) survived. Survival rates from protocol KSPNO-S-053 are encouraging and show that tumor status prior to HDCT/ASCT is an important factor to consider for improving survival rates of patients with relapsed medulloblastoma.

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Overview of KSPNO-S-053 protocol for relapsed medulloblastoma.CR, complete response; PR, partial response; PD, progressive disease; SD, stable disease.
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Figure 1: Overview of KSPNO-S-053 protocol for relapsed medulloblastoma.CR, complete response; PR, partial response; PD, progressive disease; SD, stable disease.

Mentions: Following a diagnosis of relapsed medulloblastoma, patients were treated by surgery, radiotherapy if possible, and salvage chemotherapy (SC). The KSPNO-S-053 protocol recommended SC, alternating regimens A and B for 4 cycles; however, application of these regimens was not mandatory. Regimen A consists of: cisplatin 60 mg/m2/day on day 0; etoposide 50 mg/m2/day, days 0, 1, and 2; cyclophosphamide 750 mg/m2/day, days 1 and 2; and vincristine 1.5 mg/m2/day days 0 and 7. Regimen B consists of: carboplatin 200 mg/m2/day, days 0 and 1; etoposide 50 mg/m2/day, days 0, 1, 2, 3, and 4; ifosfamide 750 mg/m2/day, days 0, 1, 2, 3, and 4; and vincristine 1.5 mg/m2/day, days 0 and 7. Other generally accepted chemotherapy agents could be added to the recommended SC or the dose of recommended SC drugs could be modified according to physicians' choice to avoid the toxicity derived from overlapping chemotherapy drugs when similar drugs were used prior to relapse. The goal of SC was to minimize tumor burden prior to HDCT so that tumor status could be considered as having complete response (CR) or partial response (PR) before HDCT1. For this reason, the numbers of cycles of SC could be added or abstracted. After HDCT1, if the tumor status shows CR, tandem transplantation was optional; but in the case of PR or stable disease (SD), tandem transplantation was obligatory, and if progressive disease (PD) was the result, the recommendation was to go off therapy (Fig. 1).


Efficacy of high-dose chemotherapy and autologous stem cell transplantation in patients with relapsed medulloblastoma: a report on the Korean Society for Pediatric Neuro-Oncology (KSPNO)-S-053 study.

Park JE, Kang J, Yoo KH, Sung KW, Koo HH, Lim do H, Shin HJ, Kang HJ, Park KD, Shin HY, Kim IH, Cho BK, Im HJ, Seo JJ, Park HJ, Park BK, Ahn HS - J. Korean Med. Sci. (2010)

Overview of KSPNO-S-053 protocol for relapsed medulloblastoma.CR, complete response; PR, partial response; PD, progressive disease; SD, stable disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908784&req=5

Figure 1: Overview of KSPNO-S-053 protocol for relapsed medulloblastoma.CR, complete response; PR, partial response; PD, progressive disease; SD, stable disease.
Mentions: Following a diagnosis of relapsed medulloblastoma, patients were treated by surgery, radiotherapy if possible, and salvage chemotherapy (SC). The KSPNO-S-053 protocol recommended SC, alternating regimens A and B for 4 cycles; however, application of these regimens was not mandatory. Regimen A consists of: cisplatin 60 mg/m2/day on day 0; etoposide 50 mg/m2/day, days 0, 1, and 2; cyclophosphamide 750 mg/m2/day, days 1 and 2; and vincristine 1.5 mg/m2/day days 0 and 7. Regimen B consists of: carboplatin 200 mg/m2/day, days 0 and 1; etoposide 50 mg/m2/day, days 0, 1, 2, 3, and 4; ifosfamide 750 mg/m2/day, days 0, 1, 2, 3, and 4; and vincristine 1.5 mg/m2/day, days 0 and 7. Other generally accepted chemotherapy agents could be added to the recommended SC or the dose of recommended SC drugs could be modified according to physicians' choice to avoid the toxicity derived from overlapping chemotherapy drugs when similar drugs were used prior to relapse. The goal of SC was to minimize tumor burden prior to HDCT so that tumor status could be considered as having complete response (CR) or partial response (PR) before HDCT1. For this reason, the numbers of cycles of SC could be added or abstracted. After HDCT1, if the tumor status shows CR, tandem transplantation was optional; but in the case of PR or stable disease (SD), tandem transplantation was obligatory, and if progressive disease (PD) was the result, the recommendation was to go off therapy (Fig. 1).

Bottom Line: The 3-yr overall survival probability and event-free survival rates +/-95% confidence intervals (CI) were 33.3+/-12.2% and 26.7% +/-11.4%, respectively.When analysis was confined to only patients who had a complete response (CR) or partial response (PR) prior to HDCT, the probability of 3-yr overall survival rates +/-95% CI was 40.0+/-15.5%.No patients with stable disease (SD) or progressive disease (PD) survived.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT
The efficacy and toxicity of high-dose chemotherapy and autologous stem cell transplantation (HDCT/ASCT) were investigated for improving the outcomes of patients with relapsed medulloblastoma. A total of 15 patients with relapsed medulloblastoma were enrolled in the KSPNO-S-053 study from May 2005 to May 2007. All patients received approximately 4 cycles of salvage chemotherapy after relapse. Thirteen underwent HDCT/ASCT; CTE and CM regimen were employed for the first HDCT (HDCT1) and second HDCT (HDCT2), respectively, and 7 underwent HDCT2. One transplant related mortality (TRM) due to veno-occlusive disease (VOD) occurred during HDCT1 but HDCT2 was tolerable with no further TRM. The 3-yr overall survival probability and event-free survival rates +/-95% confidence intervals (CI) were 33.3+/-12.2% and 26.7% +/-11.4%, respectively. When analysis was confined to only patients who had a complete response (CR) or partial response (PR) prior to HDCT, the probability of 3-yr overall survival rates +/-95% CI was 40.0+/-15.5%. No patients with stable disease (SD) or progressive disease (PD) survived. Survival rates from protocol KSPNO-S-053 are encouraging and show that tumor status prior to HDCT/ASCT is an important factor to consider for improving survival rates of patients with relapsed medulloblastoma.

Show MeSH
Related in: MedlinePlus