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Solid Cancers

Decreased morbidity and mortality of autologous hematopoietic transplants for children with malignant central nervous system tumors: the ‘Head Start’ trials, 1991–2009

Bone Marrow Transplantation volume 51, pages 945–948 (2016)Cite this article

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Abstract

Since 1991, three sequential prospective clinical trials have been conducted by the ‘Head Start’ (HS) Consortium in which young children with newly-diagnosed malignant central nervous system (CNS) tumors were treated with induction chemotherapy followed by single-cycle marrow-ablative chemotherapy and autologous hematopoietic rescue as a means of improving disease cure rate and quality of survival through avoidance (<6 years old at diagnosis) or reduction (6–10 years old) of brain irradiation. Bone Marrow (HS I) or filgrastim-mobilized peripheral hematopoietic cells (HS II and III) were obtained following recovery from the first and/or second induction cycles. Radiotherapy was administered following all chemotherapy only for patients with residual tumor following completion of induction or with age greater than 6 years at diagnosis. Two hundred and twenty-six children were enrolled on three consecutive HS trials with primary malignant CNS tumors and underwent marrow-ablative chemotherapy. The 100-day treatment-related mortality (TRM) steadily declined as did grade IV transplant-related oropharyngeal mucositis. Factors most likely associated with the decrease in TRM and morbidity are increasing experience with the marrow-ablative chemotherapy regimen combined with improved leukapheresis and post-reinfusion supportive care techniques, contributing toward improved overall survival.

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Acknowledgements

We gratefully acknowledge all of the investigators at participating ‘Head Start’ Consortium institutions who enrolled their eligible patients on these studies.

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Authors and Affiliations

  1. Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles,, CA, USA

    C Altshuler

  2. Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles,, Los Angeles,, CA, USA

    K Haley, G Dhall & L Vasquez

  3. Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders, New York University Langone Medical Center,, New York,, NY, USA

    S L Gardner

  4. Division of Hematology, Oncology and BMT, Nationwide Children’s Hospital and the Ohio State University, Columbus,, OH, USA

    J Stanek

  5. Division of Hematology, Neuro-oncology Program, Oncology and BMT, Nationwide Children’s Hospital and the Ohio State University, Columbus,, OH, USA

    J L Finlay

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  1. C Altshuler
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  2. K Haley
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  3. G Dhall
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  4. L Vasquez
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  7. J L Finlay
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for the ‘Head Start’ Consortium

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Correspondence to J L Finlay.

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Altshuler, C., Haley, K., Dhall, G. et al. Decreased morbidity and mortality of autologous hematopoietic transplants for children with malignant central nervous system tumors: the ‘Head Start’ trials, 1991–2009. Bone Marrow Transplant 51, 945–948 (2016). https://doi.org/10.1038/bmt.2016.45

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