High dose chemotherapy with autologous bone marrow rescue for children with diffuse pontine brain stem tumors

Ira J. Dunkel; James H. Garvin; Stewart Goldman; Lawrence J. Ettinger; Allen M. Kaplan; Mitchell Cairo; Hao Li; James M. Boyett; Jonathan L. Finlay

doi:10.1023/A:1005874508975

High dose chemotherapy with autologous bone marrow rescue for children with diffuse pontine brain stem tumors

Ira J. Dunkel^*, James H. Garvin, Stewart Goldman, Lawrence J. Ettinger, Allen M. Kaplan, Mitchell Cairo, Hao Li, James M. Boyett, Jonathan L. Finlay

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

74 Scopus citations

Abstract

Purpose. Diffuse pontine tumors are highly lethal, and there are few long-term survivors with the standard treatment of external beam irradiation. We investigated the effectiveness of high-dose thiotepa and etoposide-based chemotherapy regimens with autologous bone marrow rescue (ABMR) in children with pontine tumors. Patients and methods. Sixteen children with diffuse pontine tumors were treated. Ten had resistant or recurrent tumors. All ten had previously received irradiation; five had also received chemotherapy and one, beta-interferon. Three high-dose chemotherapy regimens were employed. Six patients received three days of thiotepa (300 mg/m²/day) and etoposide (250-500 mg/m²/day) (TE); two received three days of carmustine (BCNU) (200 mg/m²/day divided every 12 hours) followed by TE (BTE); and two received three days of carboplatin (500 mg/m²/day) followed by TE (CTE). Six other patients had newly-diagnosed tumors and had not received any prior treatment. They all received the BTE regimen and subsequently were treated with hyperfractionated irradiation (7200-7800 cGy) beginning approximately six weeks post-ABMR. Results. There were two toxic deaths (13%), both in previously treated patients, due to multiorgan system failure and Candida septicemia in one case each. Median survival of the patients with resistant or recurrent disease was 4.7 months (range 0.1-18.7) from time of ABMR. Median survival of the newly-diagnosed patients was 11.4 months (range 7.6-17.1) from the time of ABMR. Conclusion. High-dose chemotherapy utilizing these regimens followed by ABMR did not appear to prolong survival compared to conventional therapy in these children with pontine tumors. Alternative strategies need to be developed for this highly lethal disease.

Original language	English (US)
Pages (from-to)	67-73
Number of pages	7
Journal	Journal of Neuro-Oncology
Volume	37
Issue number	1
DOIs	https://doi.org/10.1023/A:1005874508975
State	Published - 1998

Funding

Contributing Children’s Cancer Group Investigators, Institutions, and Grant Numbers are given in the Appendix. Grant support from the Division of Cancer Treatment, National Cancer Institute, National Institutes of Health, Department of Health and Human Services. HL ad JMB are supported by grant number CA 21765 and by the American Lebanese Syrian Associated Charities.

Keywords

Autologous bone marrow rescue
Brain stem tumors
Chemotherapy
Gliomas

ASJC Scopus subject areas

Clinical Neurology
Neurology
Oncology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1023/A:1005874508975

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@article{dc8e754c635e4b53825bbc87bdef62f2,

title = "High dose chemotherapy with autologous bone marrow rescue for children with diffuse pontine brain stem tumors",

abstract = "Purpose. Diffuse pontine tumors are highly lethal, and there are few long-term survivors with the standard treatment of external beam irradiation. We investigated the effectiveness of high-dose thiotepa and etoposide-based chemotherapy regimens with autologous bone marrow rescue (ABMR) in children with pontine tumors. Patients and methods. Sixteen children with diffuse pontine tumors were treated. Ten had resistant or recurrent tumors. All ten had previously received irradiation; five had also received chemotherapy and one, beta-interferon. Three high-dose chemotherapy regimens were employed. Six patients received three days of thiotepa (300 mg/m2/day) and etoposide (250-500 mg/m2/day) (TE); two received three days of carmustine (BCNU) (200 mg/m2/day divided every 12 hours) followed by TE (BTE); and two received three days of carboplatin (500 mg/m2/day) followed by TE (CTE). Six other patients had newly-diagnosed tumors and had not received any prior treatment. They all received the BTE regimen and subsequently were treated with hyperfractionated irradiation (7200-7800 cGy) beginning approximately six weeks post-ABMR. Results. There were two toxic deaths (13%), both in previously treated patients, due to multiorgan system failure and Candida septicemia in one case each. Median survival of the patients with resistant or recurrent disease was 4.7 months (range 0.1-18.7) from time of ABMR. Median survival of the newly-diagnosed patients was 11.4 months (range 7.6-17.1) from the time of ABMR. Conclusion. High-dose chemotherapy utilizing these regimens followed by ABMR did not appear to prolong survival compared to conventional therapy in these children with pontine tumors. Alternative strategies need to be developed for this highly lethal disease.",

keywords = "Autologous bone marrow rescue, Brain stem tumors, Chemotherapy, Gliomas",

author = "Dunkel, {Ira J.} and Garvin, {James H.} and Stewart Goldman and Ettinger, {Lawrence J.} and Kaplan, {Allen M.} and Mitchell Cairo and Hao Li and Boyett, {James M.} and Finlay, {Jonathan L.}",

note = "Funding Information: Contributing Children{\textquoteright}s Cancer Group Investigators, Institutions, and Grant Numbers are given in the Appendix. Grant support from the Division of Cancer Treatment, National Cancer Institute, National Institutes of Health, Department of Health and Human Services. HL ad JMB are supported by grant number CA 21765 and by the American Lebanese Syrian Associated Charities. Copyright: Copyright 2007 Elsevier B.V., All rights reserved.",

year = "1998",

doi = "10.1023/A:1005874508975",

language = "English (US)",

volume = "37",

pages = "67--73",

journal = "Journal of Neuro-Oncology",

issn = "0167-594X",

publisher = "Kluwer Academic Publishers",

number = "1",

}

TY - JOUR

T1 - High dose chemotherapy with autologous bone marrow rescue for children with diffuse pontine brain stem tumors

AU - Dunkel, Ira J.

AU - Garvin, James H.

AU - Goldman, Stewart

AU - Ettinger, Lawrence J.

AU - Kaplan, Allen M.

AU - Cairo, Mitchell

AU - Li, Hao

AU - Boyett, James M.

AU - Finlay, Jonathan L.

N1 - Funding Information: Contributing Children’s Cancer Group Investigators, Institutions, and Grant Numbers are given in the Appendix. Grant support from the Division of Cancer Treatment, National Cancer Institute, National Institutes of Health, Department of Health and Human Services. HL ad JMB are supported by grant number CA 21765 and by the American Lebanese Syrian Associated Charities. Copyright: Copyright 2007 Elsevier B.V., All rights reserved.

PY - 1998

Y1 - 1998

N2 - Purpose. Diffuse pontine tumors are highly lethal, and there are few long-term survivors with the standard treatment of external beam irradiation. We investigated the effectiveness of high-dose thiotepa and etoposide-based chemotherapy regimens with autologous bone marrow rescue (ABMR) in children with pontine tumors. Patients and methods. Sixteen children with diffuse pontine tumors were treated. Ten had resistant or recurrent tumors. All ten had previously received irradiation; five had also received chemotherapy and one, beta-interferon. Three high-dose chemotherapy regimens were employed. Six patients received three days of thiotepa (300 mg/m2/day) and etoposide (250-500 mg/m2/day) (TE); two received three days of carmustine (BCNU) (200 mg/m2/day divided every 12 hours) followed by TE (BTE); and two received three days of carboplatin (500 mg/m2/day) followed by TE (CTE). Six other patients had newly-diagnosed tumors and had not received any prior treatment. They all received the BTE regimen and subsequently were treated with hyperfractionated irradiation (7200-7800 cGy) beginning approximately six weeks post-ABMR. Results. There were two toxic deaths (13%), both in previously treated patients, due to multiorgan system failure and Candida septicemia in one case each. Median survival of the patients with resistant or recurrent disease was 4.7 months (range 0.1-18.7) from time of ABMR. Median survival of the newly-diagnosed patients was 11.4 months (range 7.6-17.1) from the time of ABMR. Conclusion. High-dose chemotherapy utilizing these regimens followed by ABMR did not appear to prolong survival compared to conventional therapy in these children with pontine tumors. Alternative strategies need to be developed for this highly lethal disease.

AB - Purpose. Diffuse pontine tumors are highly lethal, and there are few long-term survivors with the standard treatment of external beam irradiation. We investigated the effectiveness of high-dose thiotepa and etoposide-based chemotherapy regimens with autologous bone marrow rescue (ABMR) in children with pontine tumors. Patients and methods. Sixteen children with diffuse pontine tumors were treated. Ten had resistant or recurrent tumors. All ten had previously received irradiation; five had also received chemotherapy and one, beta-interferon. Three high-dose chemotherapy regimens were employed. Six patients received three days of thiotepa (300 mg/m2/day) and etoposide (250-500 mg/m2/day) (TE); two received three days of carmustine (BCNU) (200 mg/m2/day divided every 12 hours) followed by TE (BTE); and two received three days of carboplatin (500 mg/m2/day) followed by TE (CTE). Six other patients had newly-diagnosed tumors and had not received any prior treatment. They all received the BTE regimen and subsequently were treated with hyperfractionated irradiation (7200-7800 cGy) beginning approximately six weeks post-ABMR. Results. There were two toxic deaths (13%), both in previously treated patients, due to multiorgan system failure and Candida septicemia in one case each. Median survival of the patients with resistant or recurrent disease was 4.7 months (range 0.1-18.7) from time of ABMR. Median survival of the newly-diagnosed patients was 11.4 months (range 7.6-17.1) from the time of ABMR. Conclusion. High-dose chemotherapy utilizing these regimens followed by ABMR did not appear to prolong survival compared to conventional therapy in these children with pontine tumors. Alternative strategies need to be developed for this highly lethal disease.

KW - Autologous bone marrow rescue

KW - Brain stem tumors

KW - Chemotherapy

KW - Gliomas

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JF - Journal of Neuro-Oncology

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ER -

High dose chemotherapy with autologous bone marrow rescue for children with diffuse pontine brain stem tumors

Abstract

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Keywords

ASJC Scopus subject areas

UN SDGs

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