Biological modification strategies following marrow ablative, high-dose chemotherapy (HDCT) with autologous hematopoietic stem cell rescue (AHSCR) for pediatric brain tumors.

Maintenance biology-based therapy following HDCT/AHSCR in pediatric brain tumors has not been tested as yet. Failure of the HDCT/AHSCR might be due to tumor-immunity dysregulation, reactivation of the angiogenic switch and other mechanisms. Angiogenesis has been shown to be reactivated following chemotherapy. The angiogenic factors engaged in this process in childhood brain tumors following HDCT/AHSCR have not been tested in the clinic. Metronomic chemotherapy has been found to be safe and angiogenesis inhibitors are currently tested in children. Other good possible candidates for clinical trials in this setting include retinoic acid and immunotherapy.