Journal of Clinical Oncology, Vol 11, 2226-2233, Copyright © 1993 by American Society of Clinical Oncology
Patterns of relapse after autologous purged bone marrow transplantation for neuroblastoma: a Childrens Cancer Group pilot study
KK Matthay, JB Atkinson, DO Stram, M Selch, CP Reynolds and RC Seeger
Department of Pediatrics, University of California School of Medicine, San Francisco.
PURPOSE: The goal of this investigation was to determine if comparing sites
of neuroblastoma at relapse after myeloablative chemoradiotherapy and
purged autologous bone marrow transplantation (ABMT) with sites of disease
at diagnosis and before ABMT could provide insight to the reasons for
treatment failure. PATIENTS AND METHODS: Ninety-nine patients with
high-risk neuroblastoma underwent ABMT after induction chemotherapy,
surgery +/- local radiation (RT) and then myeloablative therapy with
teniposide (or etoposide), melphalan, doxorubicin, cisplatin, and
total-body irradiation (TBI). RESULTS: Forty-one of 84 assessable patients
(15 toxic deaths) developed progressive disease 1 to 44 months after ABMT.
The overall probability of relapse 36 months after ABMT was 49%. Tumor
recurred in primary (n = 22), bone (n = 20), bone marrow (n = 18), lung (n
= 3), and other sites (n = 9). Eight patients relapsed in the primary site
alone, 14 in primary and distant sites, and 19 in distant sites only. Of 41
patients with progressive disease, 33 have died, with a median interval
from relapse to death of 4 months. Both bone and bone marrow involvement at
diagnosis correlated with specific relapse in that site (P < .05). Bone
marrow tumor content at harvest greater than 0.1% also correlated with bone
marrow relapse (P = .001). There was an association between incomplete
resection of the primary tumor at diagnosis and relapse in that site (P =
.06). CONCLUSION: Neuroblastoma normally recurs in multiple sites after
ABMT, particularly in areas of previous disease. More intensive treatment
to known areas of disease (aggressive early surgery, effective
myeloablative consolidation therapy) and post-ABMT therapy for minimal
residual disease should be studied for their potential to decrease the
frequency of relapse.
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