Stem Cell Transplantation in Neuroblastoma: Iranian Experience

Abstract

Introduction: Neuroblastoma is the most common extracranial solid tumor in children, accounting for 8% to 10% of all childhood cancers. Significantly, autologous transplantation appeared to have the largest impact on survival for the high risk subset of patients, such as those with N-MYC amplified metastatic disease diagnosed after age 2 years.
Patients and methods: This study includes high risk, relapse, or refractory patients with NBL who underwent SCT from 1998 up-to 2009. There were nine patients with NBL consisting of seven males and two females. Among nine neuroblastoma patients who received transplantation, eight patients received autologous transplantation and one patient received allogenic transplantation of full matched sibling. The main conditioning regimen was CEM; consist of Carboplatin (400 mg/m² for 3 days), Etoposide (200 mg /m2 for 3 days), and Melphalan (75 mg /m² for2 days). Patients transplanted after 2008 received 13-cis-retinoic-Acid 120-160 mg/m²/2weeks in month, as maintenance from days sixty after SCT until one year.
Results: Median age of recipients was 5.5 years (range: 4-8 years). All patients were in stage IV of NBL. The common pathological result was stromal poor. Primary involved site at diagnosis was adrenal gland in patients. The source of stem cells was Peripheral Blood in seven patients and Bone Marrow in two patients. The median duration required to achieving an Absolute Neutrophil Count (ANC) ≥ 500×10⁹/µl was 11 days (range: 8-14 days). The median duration required to achieving a platelet count of ≥ 20×10⁹/μl was 19 days (range 10-70 days). Six of nine recipients had relapsed. At present four patients are alive that one of them had relapse and three ones are in complete remission and all of them passed 250 days after SCT. Relapse was the only cause of death.
Conclusion: Regarding to the studies we can conclude in Neuroblastoma patients Stem Cell Transplantation is better than chemotherapy alone, the allogeneic Stem Cell Transplantation has no preference to autologous SCT and Peripheral Stem Cell Transplantation is significantly better than Bone Marrow.