Marrow-ablative chemotherapy followed by tandem autologous hematopoietic cell transplantation in pediatric patients with malignant brain tumors
To improve survival in young children with malignant brain tumors, irradiation-avoiding or -minimizing marrow-ablative chemotherapy (HDCx) with autologous hematopoietic cell transplantation (AuHCT) has been investigated. We evaluated the outcome of 44 children with malignant brain tumors treated with HDCx and tandem AuHCT at Children's Hospital Los Angeles between June 1999 and July 2012. Forty-four children with malignant brain tumors were studied. Twenty-one had medulloblastoma/primitive neuro-ectodermal tumor, eight atypical teratoid/rhabdoid tumor (ATRT), five high-grade glioma, four malignant germ cell tumor, three ependymoma and three choroid plexus carcinoma. Twenty-nine patients received three tandem transplants and 15 received two tandem transplants, respectively. The 5-year PFS and overall survivals (OS) for all patients were 46.3 ± 8.2% and 51.7 ± 8.5%, respectively. The PFS and OS for 27 newly diagnosed patients were 68.9 ± 9.9% and 73.5 ± 9.3%, respectively, compared with 17 transplanted at relapse 11.8 ± 9.8% (P < 0.001) and 15.1 ± 12.3% (P = 0.0231), respectively. The 5-year PFS and OS in 13 previously unirradiated patients were 74 ± 13% and 74 ± 13% versus 33.2 ± 9.8% and 40.2 ± 10.6% in 31 irradiated patients (P = 0.11 and P = 0.239), respectively. One patient died of transplant-related toxicity. HDCx with tandem AuHCT is feasible and safe in children with malignant brain tumors with encouraging irradiation-free survival in newly diagnosed children.