Treatment of advanced neuroblastoma with supralethal chemotherapy, radiation, and allogeneic or autologous marrow reconstitution.

Abstract

Ten children with recurrent metastatic (stage IV) neuroblastoma received local radiation therapy, supralethal chemotherapy and total-body irradiation. Rescue with infusions of either allogeneic (4 patients) or autologous (6 patients) bone marrow followed. The drugs given to the first 2 patients were individualized combinations based on previous tumor responses. Both patients died with recurrent tumor 3 and 9 mo. posttransplant. The 8 remaining patients were treated more uniformly with local irradiation, VM-26 [teniposide] doxorubicin, melphalan (L-phenylalanine mustard) and 1000-rad total-body irradiation in 3 fractions. Two of these patients had cardiac dysfunction and received no doxorubicin. Three children died in the immediate posttransplant period with disseminated fungal infections. A 4th relapsed and died 9 mo. posttransplant. As of Dec. 1, 1983, 2 children who received allogeneic marrow grafts have survived in complete remission for 54 and 36 mo., and 2 children who received autologous marrow grafts have survived in complete remission for 35 and 22 mo. Relapsed metastatic neuroblastoma can be controlled by supralethal combinations of chemotherapy and irradiation coupled with bone-marrow rescue.