TY - JOUR
T1 - High-dose chemotherapy with autologous stem cell transplantation in adults with recurrent embryonal tumors of the central nervous system
AU - Gill, Paula
AU - Litzow, Mark
AU - Buckner, Jan
AU - Arndt, Carola
AU - Moynihan, Timothy
AU - Christianson, Teresa
AU - Ansell, Stephen
AU - Galanis, Evanthia
PY - 2008/4/15
Y1 - 2008/4/15
N2 - BACKGROUND. Embryonal central nervous system (CNS) tumors (medulloblastoma, cerebral neuroblastoma, pineoblastoma, and primitive neuroectodermal tumors) are rare in adults. Recurrent disease has an extremely poor outcome. The use of high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) has demonstrated promising results in children with recurrent disease, but there are only limited data regarding its role in adults. The purpose of the current study was to evaluate adult patients with embryonal CNS tumors who were treated with HDC with ASCT and compare their outcomes with those of patients who received conventional-dose chemotherapy. METHODS. The authors reviewed the medical records of 23 adult patients (age ≥18 years) who were treated at the Mayo Clinic for recurrent embryonal CNS tumors between 1976 and 2004. The authors compared treatment with HDC with ASCT (10 patients) with an historic control of patients treated with conventional-dose chemotherapy (nitrosourea based, cisplatin based, or both) (13 patients). RESULTS. HDC with ASCT was associated with increased survival (P = .044) and a longer time to disease progression (TTP) (P = .028). The conventional-dose chemotherapy group had a median TTP of 0.58 years and a median survival of 2.00 years. The HDC with ASCT group had a median TTP of 1.25 years and a median survival of 3.47 years. When restricted to patients receiving ASCT after first disease recurrence, the median TTP was 2.5 years and the median survival was 4.16 years. Toxicities were similar in both groups. CONCLUSIONS. Improvements in the median TTP and survival noted with the administration of HDC with ASCT, as well as the acceptable toxicity of this regimen, supports consideration of its use in adults with recurrent embryonal CNS tumors.
AB - BACKGROUND. Embryonal central nervous system (CNS) tumors (medulloblastoma, cerebral neuroblastoma, pineoblastoma, and primitive neuroectodermal tumors) are rare in adults. Recurrent disease has an extremely poor outcome. The use of high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) has demonstrated promising results in children with recurrent disease, but there are only limited data regarding its role in adults. The purpose of the current study was to evaluate adult patients with embryonal CNS tumors who were treated with HDC with ASCT and compare their outcomes with those of patients who received conventional-dose chemotherapy. METHODS. The authors reviewed the medical records of 23 adult patients (age ≥18 years) who were treated at the Mayo Clinic for recurrent embryonal CNS tumors between 1976 and 2004. The authors compared treatment with HDC with ASCT (10 patients) with an historic control of patients treated with conventional-dose chemotherapy (nitrosourea based, cisplatin based, or both) (13 patients). RESULTS. HDC with ASCT was associated with increased survival (P = .044) and a longer time to disease progression (TTP) (P = .028). The conventional-dose chemotherapy group had a median TTP of 0.58 years and a median survival of 2.00 years. The HDC with ASCT group had a median TTP of 1.25 years and a median survival of 3.47 years. When restricted to patients receiving ASCT after first disease recurrence, the median TTP was 2.5 years and the median survival was 4.16 years. Toxicities were similar in both groups. CONCLUSIONS. Improvements in the median TTP and survival noted with the administration of HDC with ASCT, as well as the acceptable toxicity of this regimen, supports consideration of its use in adults with recurrent embryonal CNS tumors.
KW - Autologous stem cell transplantation
KW - Embryonal central nervous system tumors
KW - High-dose chemotherapy
KW - Medulloblastoma
KW - Survival
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U2 - 10.1002/cncr.23362
DO - 10.1002/cncr.23362
M3 - Article
C2 - 18300237
AN - SCOPUS:42149117803
SN - 0008-543X
VL - 112
SP - 1805
EP - 1811
JO - Cancer
JF - Cancer
IS - 8
ER -