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Treatment of Relapsed Wilms’ Tumor With High-Dose Therapy and Autologous Hematopoietic Stem-Cell Rescue: The Experience at Children’s Memorial Hospital

From the Departments of Pediatrics, Surgery, Preventive Medicine, and Radiation Oncology and the Biometry Section, Northwestern University Feinberg School of Medicine, the Comprehensive Robert H. Lurie Cancer Center; and Children’s Memorial Hospital, Chicago, IL; University of Michigan; C.S. Motts Children’s Hospital, Ann Arbor, MI; Indiana University; and Riley Children’s Hospital, Indianapolis, IN

Address reprint requests to Morris Kletzel, MD, FAAP, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614; e-mail: mkletzel{at}northwestern.edu

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.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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