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Conditioning Regimens

5-day/5-drug myeloablative outpatient regimen for resistant neuroblastoma

Bone Marrow Transplantation volume 48, pages 642–645 (2013)Cite this article

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Abstract

5-day/5-drug (5D/5D) is a novel high-dose regimen administered with autologous hematopoietic SCT (HSCT). It was designed to maximize cytoreduction via high dosing of synergistically interacting agents, while minimizing morbidity in patients with resistant neuroblastoma (NB) and ineligible for clinical trials due to myelosuppression from previous therapy. 5D/5D comprises carboplatin 500 mg/m2/day on days 1–2, irinotecan 50 mg/m2/day on days 1–3, temozolomide 250 mg/m2/day on days 1–3, etoposide 200 mg/m2/day on days 3–5 and cyclophosphamide 70 mg/kg/day on days 4–5. HSCT is on day 8. Sixteen patients received 21 courses. Treatment was in the outpatient clinic. Responses were noted against progressive disease (PD) that had developed while patients were off, or receiving only low-dose, chemotherapy but not against PD that emerged despite high-dose chemotherapy. Responses were also seen in patients with PD or stable disease after 131I-metaiodobenzylguanidine therapy. Grade 3 toxicities were limited to transient elevations in liver enzymes (three courses) and hyponatremia (one course). Bacteremia occurred in 2/21 (10%) courses. Hematological recovery allowed patients to be enrolled on clinical trials. In conclusion, 5D/5D (including HSCT) spares vital organs, entails modest morbidity, shows activity against resistant NB and helps patients meet eligibility requirements for formal clinical trials.

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Acknowledgements

Supported, in part, by grants from the National Institutes of Health (CA10450), Bethesda, MD; the Robert Steel Foundation, New York, NY; and Katie’s Find A Cure Fund, New York, NY.

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

    B H Kushner, S Modak, K Kramer, E M Basu, S S Roberts & 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., Modak, S., Kramer, K. et al. 5-day/5-drug myeloablative outpatient regimen for resistant neuroblastoma. Bone Marrow Transplant 48, 642–645 (2013). https://doi.org/10.1038/bmt.2012.202

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