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Conditioning Regimens

Topotecan, thiotepa, and carboplatin for neuroblastoma: failure to prevent relapse in the central nervous system

Bone Marrow Transplantation volume 37, pages 271–276 (2006)Cite this article

Abstract

We report on a three-drug myeloablative regimen designed to consolidate remission and to prevent central nervous system (CNS) relapse of high-risk neuroblastoma (NB). Sixty-six NB patients received topotecan 2 mg/m2/day, × 4 days; thiotepa 300 mg/m2/day, × 3 days; and carboplatin ∼500 mg/m2/day, × 3 days. Post-SCT treatments included radiotherapy, immunotherapy, 13-cis-retinoic acid, ±oral etoposide. Significant nonhematologic toxicities were mucositis and skin-related in all patients, convulsions in three patients, and cardiac failure and venocclusive disease of liver in one patient each. Grade 2 hepatotoxicity led to truncating cytoreduction in two patients; both later relapsed in brain. Among 46 patients transplanted in first complete/very good partial remission (CR/VGPR), event-free survival is 54% (s.e.±8%) at 36 months post-SCT; notable events were three non-NB-related deaths (adenovirus on day +9, bowel necrosis at 5 months, multiorgan failure at seven months) and four relapses in brain. Of 12 patients transplanted with evidence of NB, two became long-term event-free survivors and two relapsed in the brain. Of eight patients transplanted in second or greater CR/VGPR, one became a long-term event-free survivor and seven relapsed though not in the CNS. This regimen has manageable toxicity but does not prevent CNS relapse.

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Acknowledgements

Supported in part by Grants from the National Cancer Institute (CA61017, CA72868), Bethesda, MD; Hope Street Kids, Alexandria, VA; the Justin Zahn Fund, New York, NY; the Katie's Find A Cure Fund, New York, NY; and the Robert Steel Foundation, New York, NY.

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  1. Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    B H Kushner, K Kramer, S Modak, N A Kernan, L M Reich, K Danis & N-KV Cheung

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  1. B H Kushner
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Correspondence to B H Kushner.

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Kushner, B., Kramer, K., Modak, S. et al. Topotecan, thiotepa, and carboplatin for neuroblastoma: failure to prevent relapse in the central nervous system. Bone Marrow Transplant 37, 271–276 (2006). https://doi.org/10.1038/sj.bmt.1705253

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