The evaluation of induction chemotherapy regimens for high-risk neuroblastoma in South African children*. (18th May 2020)

• Record Type: Journal Article
• Authors: Van Heerden, Jaques; Geel, Jennifer; Hendricks, Marc; Wouters, Kristien; Büchner, Ané; Naidu, Gita; Hadley, G. P.; Du Plessis, Jan; Van Emmenes, Barry; Van Zyl, Anel; Vermeulen, Johani; Kruger, Mariana
• Is Part Of: Pediatric hematology and oncology. Volume 37:Number 4(2020)
• Page Start: 300
• Page End: 313
• Publication Date: 2020-05-18
• Subjects: High risk -- induction chemotherapy -- neuroblastoma -- South Africa; Pediatric hematology -- Periodicals; Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Hematologic Diseases -- Child; Hematologic Diseases -- Infant; Neoplasms -- Child; 618.9215
• DOI: 10.1080/08880018.2020.1717698
• Languages: English
• ISSNs: 0888-0018

Abstract

Abstract: Achieving remission after induction therapy in high-risk neuroblastoma (HR-NB) is of significant prognostic importance. This study investigated remission after induction-chemotherapy using three standard neuroblastoma protocols in the South African (SA) setting. Retrospective data of 261 patients with HR-NB diagnosed between January 2000 and December 2016, who completed induction chemotherapy with standard treatment protocols were evaluated. The treatment protocols were either OPEC/OJEC or the St Jude NB84 protocol (NB84) or rapid COJEC (rCOJEC). The postinduction metastatic complete remission (mCR) rate, 2-year overall survival (OS) and 2-year event free survival (EFS) were determined as comparative denominators. The majority (48.3%; n = 126) received OPEC/OJEC, while 70 patients received (26.8%) rCOJEC and 65 (24.9%) NB84. Treatment with NB84 had the best mCR rate (36.9%), followed by OPEC/OJEC (32.5%) and rCOJEC (21.4%). The 2-year OS of treatment with NB84 was 41% compared to OPEC/OJEC (35%) and rCOJEC (24%) ( p = 0.010). The 2-year EFS of treatment with NB84 was 37% compared to OPEC/OJEC (35%) and rCOJEC (18%) ( p = 0.008). OPEC/OJEC had the least treatment-related deaths (1.6%) compared to rCOJEC (7.1%) and NB84 (7.5%) ( p = 0.037). On multivariate analysis LDH ( p = 0.023), ferritin ( p = 0.002) and INSS stage ( p = 0.006) were identified as significant prognostic factors for OS. The induction chemotherapy was not significant for OS ( p = 0.18), but significant for EFS ( p = 0.08) Treatment with NB84 achieved better mCR, OS and EFS, while OPEC/OJEC had the least treatment-related deaths. In resource-constrained settings, OPEC/OJEC is advised as induction chemotherapy in HR-NB due to less toxicity as reflected in less treatment-related deaths.