Tr

infuse

Biologic Therapy stem cells

VCR/Adr/CTX

tr surgery

Ctx/E/C

Melphalan/TBI

tr tr infuse XRT stem cells

Figure 11.6.1

Top panel. Schema of the CHOP/DFCI tandem transplant study. Bottom panel. Event-free survival (EFS) from diagnosis. C carboplatin, E etoposide, Cis cisplatin, I ifosfamide, VCR vincristine, Adr adriamycin, CTX cyclophosphamide, TBI total body irradiation

Figure 11.6.2

Event-free survival (EFS) from diagnosis on the Chicago "triple tandem" transplant study. OS overall survival

Two other experimental approaches to transplantation are worthy of mention. Combining therapeutic doses of [131I-m]IBG with high-dose chemotherapy showed preliminary evidence of efficacy in high-risk patients (Klingebiel et al. 1998; Yanik et al. 2002). Another experimental approach to NB transplant is the use of allogeneic transplant. A graft-vs-tumor effect, thought to accompany the graft-vs-host response,has been demonstrated in leukemias, especially chronic myelogenous leukemia. This effect has not convincingly been demonstrated in the setting of solid tumors (Srinivasan et al. 2004). Retrospective analyses of conventional allogeneic BMT for NB have failed to show any benefit over standard therapy (Matthay et al. 1994; Philip et al. 1997). With the advent of non-myeloablative transplant regimens, the interest in allogeneic transplant in NB has been revived, with the hope that reduced intensity will reduce TRM in order to detect a therapeutic benefit. At this point, there are no data to justify this approach in children undergoing their primary treatment for high-risk NB.

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