Matthay K K, Atkinson J B, Stram D O, Selch M, Reynolds C P, Seeger R C
Department of Pediatrics, University of California School of Medicine, San Francisco.
J Clin Oncol. 1993 Nov;11(11):2226-33. doi: 10.1200/JCO.1993.11.11.2226.
The goal of this investigation was to determine if comparing sites of neuroblastoma at relapse after myeloablative chemoradiotherapy and purged autologous bone marrow transplantation (ABMT) with sites of disease at diagnosis and before ABMT could provide insight to the reasons for treatment failure.
Ninety-nine patients with high-risk neuroblastoma underwent ABMT after induction chemotherapy, surgery +/- local radiation (RT) and then myeloablative therapy with teniposide (or etoposide), melphalan, doxorubicin, cisplatin, and total-body irradiation (TBI).
Forty-one of 84 assessable patients (15 toxic deaths) developed progressive disease 1 to 44 months after ABMT. The overall probability of relapse 36 months after ABMT was 49%. Tumor recurred in primary (n = 22), bone (n = 20), bone marrow (n = 18), lung (n = 3), and other sites (n = 9). Eight patients relapsed in the primary site alone, 14 in primary and distant sites, and 19 in distant sites only. Of 41 patients with progressive disease, 33 have died, with a median interval from relapse to death of 4 months. Both bone and bone marrow involvement at diagnosis correlated with specific relapse in that site (P < .05). Bone marrow tumor content at harvest greater than 0.1% also correlated with bone marrow relapse (P = .001). There was an association between incomplete resection of the primary tumor at diagnosis and relapse in that site (P = .06).
Neuroblastoma normally recurs in multiple sites after ABMT, particularly in areas of previous disease. More intensive treatment to known areas of disease (aggressive early surgery, effective myeloablative consolidation therapy) and post-ABMT therapy for minimal residual disease should be studied for their potential to decrease the frequency of relapse.
本研究的目的是确定在清髓性放化疗及净化自体骨髓移植（ABMT）后复发时的神经母细胞瘤部位与诊断时及ABMT前的疾病部位进行比较，是否能为治疗失败的原因提供见解。
99例高危神经母细胞瘤患者在诱导化疗、手术±局部放疗（RT），然后用替尼泊苷（或依托泊苷）、美法仑、阿霉素、顺铂及全身照射（TBI）进行清髓性治疗后接受了ABMT。
84例可评估患者（15例死于毒性反应）中有41例在ABMT后1至44个月出现疾病进展。ABMT后36个月的总体复发概率为49%。肿瘤在原发部位（n = 22）、骨（n = 20）、骨髓（n = 18）、肺（n = 3）及其他部位（n = 9）复发。8例患者仅在原发部位复发，14例在原发部位和远处部位复发，19例仅在远处部位复发。在41例疾病进展的患者中，33例已死亡，从复发到死亡的中位间隔时间为4个月。诊断时骨和骨髓受累均与该部位的特定复发相关（P <.05）。采集时骨髓肿瘤含量大于0.1%也与骨髓复发相关（P =.001）。诊断时原发肿瘤切除不完全与该部位复发之间存在关联（P =.06）。
ABMT后神经母细胞瘤通常在多个部位复发，尤其是在先前疾病的部位。应研究对已知疾病部位进行更强化的治疗（积极的早期手术、有效的清髓性巩固治疗）及ABMT后针对微小残留疾病的治疗，以探讨其降低复发频率的潜力。
