Summary
Fifteen children with advanced neuroblastoma according to Evans' classification (1 with stage III and 14 with stage IV) were treated with high-dose melphalan (HDM) followed by autologous bone marrow transplantation. Before HDM, all patients had been extensively treated with multimodality therapy for a median duration of 9 months. At the time of HDM, seven children were in partial remission (PR) with measurable residual tumor and 8 were in complete remission (CR) or good partial remission (GPR). No reduction in measurable tumor size was observed in any of the PR patients. However, when HDM was used as consolidation therapy (CR and GPR patients) survival appeared encouraging, since five of eight patients are alive with no evidence of disease at (NED) 29+ to 54+ mouths after HDM. Tolerance of this high-dose chemotherapy was satisfactory; gastrointestinal toxicity appeared to be the most important limiting factor. These results suggest that chemotherapy including high-dose melphalan is promising when used as consolidation therapy in patients who have already attained CR with conventional therapies.
Similar content being viewed by others
References
Beaujean F, Hartmann O, Le Forestier C, et al (1984) Autologous cryopreserved bone marrow in 40 patients: In vitro studies and clinical results. Biomed Pharmacother 38:348–352
Cornbleet MA, McElwain TJ, Kumar PT, et al (1983) Treatment of advanced malignant melanoma with high-dose melphalan and autologous bone marrow transplantation. Br J Cancer 48:329–334
Evans AE, d'Angio GL Randolph J (1971) A proposed staging for children with neuroblastoma. Cancer 27:374–378
Finklestein JZ, Klemperer MR, Evans AE, et al (1979) Multiagent chemotherapy for children with metastatic neuroblastoma. A report from the children's cancer study group. Med Pediatr Oncol 6:179–188
Gale RP (1980) Clinical trials of bone marrow transplantation in leukemia. In: Gale RP, Fox CF (eds) Biology of bone marrow transplantation. Academic, New York, p 11
Gasparini M, Bellani FF, Musumeci R, et al (1974) Response and survival of patients with metastatic neuroblastoma after combination chemotherapy with adriamycin, cyclophosphamide and vincristine. Cancer Chemother Rep 58:365–370
Graham-Pole J, Lazarus HM, Herzig RH, et al (1984) High-dose melphalan therapy for the treatment of children with refractory neuroblastoma and Ewing's sarcoma. Am J Pediatr. Hematol Oncol 6:17–26
Hartmann O, Scopinaro M, Tournade MF, et al (1983) Neuroblastomes traités à l'Institut Gustave-Roussy de 1975 à 1979. Arch Fr Pediatr 40:15–21
Hartmann O, Pein F, Beaujean F, et al (1984) High-dose polychemotherapy with autologous bone marrow transplantation in children with relapsed lymphomas. J Clin Oncol 2: 979–985
Hartmann O, Beaujean F, Bayet S, et al (1985) Autologous bone marrow transplantation: role of cryoperservation, number of cells infused and nature of high-dose chemotherapy. Eur J Cancer 21:53–60
Helson L (1979) Investigational chemotherapy of neuroblastoma. J Fl Med Assoc 66:284–287
Kretschmar CS, Frantz CN, Rosen EM, et al (1984) Improved prognosis for infants with stade IV neuroblastoma. J Clin Oncol 2:799–803
Lazarus HM, Herzig RH, Graham-Pole T, et al (1983) Intensive melphalan chemotherapy and cryopreserved autologous bone marrow transplantation for the treatment of refractory cancer. J Clin Oncol 1:359–367
Maraninchi D, Abecassis MP, Gastaut TA, et al (1983) High-dose melphalan and autologous bone marrow transplant for relapsed acute leukemia. Cancer Chemother Pharmacol 10: 109–111
Maraninchi D, Pico JL, Hartmann O, et al (1985) High-dose melphalan with or without marrow transplantation: a study of dose-effect in patients with refractory and/or relapsed acute leukemias. Cancer Treat Rep (to be published)
McElwain TJ, Hedley DW, Gordon MY, et al (1979a) High dose melphalan and non-cryopreserved autologous bone marrow treatment of malignant melanoma and neuroblastoma. Exp Haematol 7 [Suppl 5]:360–371
McElwain TJ, Hedley DW, Burton G, et al (1979b) Marrow autotransplantation accelerates haematological recovery in patients with melanoma treated with high-dose melphalan. Br J Cancer 40:72–80
Ninane J, Pritchard J, Malpas JS (1981) Treatment of advanced neuroblastoma: does adriamycin contribute? Arch Dis Child 50:544–548
Pritchard J, McElwain TJ, Graham-Pole J (1982) High-dose melphalan with autologous bone marrow for advanced neuroblastoma. Br J Cancer 45:86–94
Thomas ED (1982) The use and potential of bone marrow allograft and whole-body irradiation in the treatment of leukemia. Cancer 50:1449–1454
Thomas ED, Storb R (1970) Technic of human marrow grafting. Blood 36:507–515
Zucker JM (1974) Retrospective study of 462 neuroblastoma treated between 1950 and 1970. Maandschr Kindergeneesk 42:369–385
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hartmann, O., Kalifa, C., Benhamou, E. et al. Treatment of advanced neuroblastoma with high-dose melphalan and autologous bone marrow transplantation. Cancer Chemother. Pharmacol. 16, 165–169 (1986). https://doi.org/10.1007/BF00256169
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00256169