Comparison of toxicity following different conditioning regimens (busulfan/melphalan and carboplatin/etoposide/melphalan) for advanced stage neuroblastoma: Experience of two transplant centers. (28th November 2015)

• Record Type: Journal Article
• Authors: Elborai, Yasser; Hafez, Hanafy; Moussa, Emad A.; Hammad, Mahmoud; Hussein, Hany; Lehmann, Leslie; Elhaddad, Alaa
• Is Part Of: Pediatric transplantation. Volume 20:Number 2(2016:Mar.)
• Page Start: 284
• Page End: 289
• Publication Date: 2015-11-28
• Subjects: neuroblastoma -- autologous hematopoietic stem cell transplantation (HSCT) -- carboplatin -- etoposide -- melphalan (CEM) -- busulfan/melphalan (Bu/Mel) -- renal toxicity; Transplantation of organs, tissues, etc. in children -- Periodicals; 617.95408305
• DOI: 10.1111/petr.12638
• Languages: English
• ISSNs: 1397-3142

Abstract

Abstract: The outcome for advanced neuroblastoma has improved with combined modality therapy: induction chemotherapy, surgery, and consolidation with high‐dose chemotherapy/autologous HSCT, followed by local radiation, cisretinoic acid, and recently antibody therapy. In the United States, the most common conditioning regimen is CEM, while in Europe/Middle East, Bu/Mel has been widely used; it remains unclear which regimen has the best outcome. Assess renal, hepatic, and infectious toxicity through Day+100 in 2 different regimens. Retrospective comparison between CEM‐DFCHCC Boston and Bu/Mel‐ CCHE‐57357. Thirty‐five patients, median age 4, in Boston (2007–2011) and 38 patients, median age 3, in Cairo (2009–2011). Renal toxicity; creatinine was significantly higher in CEM than Bu/Mel: 57% (median day+90) vs. 29% (median>day+100), p = 0.004. One CEM patient died from renal dialysis at day+19. Hepatic toxicity was significantly higher in CEM than Bu/Mel: 80% (median day+26) vs. 58% (median day+60), p = 0.04. In infectious complications with CEM 14%, bacteremia (n = 4) and fungemia (n = 1), 3 had culture‐negative sepsis requiring vasopressors. With Bu/Mel 18%, bacteremia (n = 7), none required pressors, p = 0.4. Bu/Mel was associated with less acute hepatic and renal toxicity and thus may be preferable for preserving organ functions.