¹Department of Pediatric Hematology/Oncology, University of Essen, Germany

²Department of Pediatric Hematology/Oncology, University of Jena, Germany

³Department of Pediatric Hematology/Oncology, University of Bonn, Germany

⁴Department of Pediatric Hematology/Oncology, University of Düsseldorf, Germany

⁵Department of Pediatric Hematology/Oncology, University of Cologne, Germany

⁶Department of Pediatric Hematology/Oncology, University of Heidelberg, Germany

⁷Department of Pediatric Hematology/Oncology, University of Freiburg, Germany

⁸Department of Pediatric Hematology/Oncology, University of Hamburg, Germany

⁹Department of Pediatric Hematology/Oncology, University of Ulm, Germany

¹⁰Department of Pediatric Hematology/Oncology, University of Halle, Germany

¹¹Department of Pediatric Hematology/Oncology, University of Homburg/Saar, Germany

¹²Department of Pediatric Hematology, Oncology and Immunology, Olga-Hospital, Stuttgart, Germany

¹³Department of Pediatric Hematology/Oncology, University of Frankfurt, Germany

Correspondence to: Dr B Kremens, Universitäts-Kinderklinik, Hufelandstr.55, D-45122 Essen, Germany

Children with Wilms tumor who have a particular risk of failure at relapse or at primary diagnosis were treated with high-dose chemotherapy (HDC) and autologous peripheral blood stem cell rescue in order to improve their probability of survival. From April 1992 to December 1998, 23 evaluable patients received HDC within the German Cooperative Wilms Tumor Studies. Nineteen were given melphalan, etoposide and carboplatin (MEC); the others received different regimens. The dose of carboplatin was adjusted according to renal function. Indications for HDC were high-risk relapse in 20 patients, bone metastases in two patients and no response in one patient. Fourteen of 23 patients are alive after a median observation time of 41 months, 11 of 14 in continuous complete remission, three in CR after relapse post HDC. The estimated survival and event-free survival for these patients are 60.9% and 48.2%. Twelve children relapsed after HDC; nine of them died within 12 months and three are surviving from 20 to 33 months after relapse. The main toxicities were hematologic, mucositis and renal (tubular dysfunction; intermittent hemodialysis in one patient). There were no toxic deaths. About half of the children suffering from Wilms tumor with very unfavorable prognostic factors survive disease-free after HDC for over 3 years. Besides hematological toxicity, mucositis and infections, renal function is at risk during HDC. With dose adjustment on glomerular filtration rate, however, no permanent renal failure was observed.

Bone Marrow Transplantation (2002) 30, 893-898. doi:10.1038/sj.bmt.1703771

Wilms tumor; high-dose chemotherapy; autologous bone marrow transplantation