TITLE:
The Impact of Pretransplant Disease Characteristics on the Outcome of Autologous Stem Cell Transplantation for Neuroblastoma with High-Risk Features: A Retrospective Model from a Limited Resources Country
AUTHORS:
Ahmed Elhemaly, Mahmoud Hammad, Mohamed Saad Zaghloul, Maged Elshafie, Naglaa Elkinaae, Mohamed Khaled, Alaa El-Haddad
KEYWORDS:
Neuroblastoma, Limited-Resource, Autologous Bone Marrow Transplant, Busulphan, Melphalan
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.10 No.6,
June
14,
2019
ABSTRACT: High-risk neuroblastoma
still has poor survival outcome. Improvement of outcome is attributed to the
consolidation of chemotherapy by autologous bone marrow transplant. Further
improvement of the outcome by tandem autologous transplant is followed by immune
therapy. We aimed with this study to
correlate initial disease characteristics with the outcome of transplanted
high-risk neuroblastoma. A retrospective analysis was done
for 73 transplanted patients. Patients were treated
in Children’s Cancer Hospital Egypt from July 2012 to July 2015. Seventy
patients received Busulphan/Melphalan conditioning. The 3-year overall survival (OS) and event-free
survival (EFS) was 63.3% and 51.3%, respectively. Disease
stage did not impact the OS and EFS, P = 0.54 and 0.62 respectively. Status of
MYCN did not reflect statistically on outcome for tumors with amplified
compared to nonamplified (EFS, 49% and 63.1%, respectively). Response after
induction chemotherapy pointed that patients who had objective response
(complete response, very good partial response and partial response) were
better compared to those with less response with EFS and OS of 53.3% and 64.2%
compared to 49.3% and 63.5%, respectively, which may indicate that
chemo-sensitive tumors have better outcome. By the end of the study,
twenty-seven patients relapsed, out of them 25 patients died. Pretransplant
risk features for neuroblastoma was nullified by autologous stem cell
transplant. The modest outcome observed, highlights some limitations that need
to be sorted out in countries with limited resources. The introduction of
immune therapy and tandem transplant is needed to achieve a better outcome, yet
it adds to more financial burden.