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ctt-journal > Kazantsev et al. (Abstract)

Kazantsev et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 12
doi: 10.3205/ctt-2011-No12-abstract62

© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "5th Raisa Gorbacheva Memorial Meeting Hematopoietic Stem Cell Transplantation in Children and Adults", Saint Petersburg, Russia, September 18–20, 2011

Preliminary Program

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Possible treatment strategies in high-risk pediatric Ewing’s Sarcoma/PNET

Ilya V. Kazantsev1, Tatjana V. Youhta2, Anastasia Yu. Kazantseva1, Asmik G. Gevorgyan1, Elena V. Morozova1, Svetlana A. Safonova2, Yury A. Punanov2, Liudmila S. Zubarovskaya1, Boris V. Afanasyev1

1R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, St. Petersburg, Russia; 2Federal State Institution N.N.Petrov Research Institute of Oncology, St. Petersburg, Russia

Correspondence: Ilya V. Kazantsev, R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, 6/8, Tolstoy str., St. Petersburg, 197022, Russia, E-mail: Ilya_Kazantsev@spam is badinbox.ru

Abstract

Aim: The prognosis for patients with high-risk Ewing sarcoma/PNET treated with conventional multimodal therapy is still unfavorable; with a 5-year EFS of 20–30%. High-dose chemotherapy (HDCT) with autologous (auto-HSCT) or allogeneic (allo-HSCT) hematopoietic stem cell transplantation may allow an improvement in prognosis for this patient group.

Methods: From February 2003 to March 2010 27 pediatric patients with high-risk Ewing’s sarcoma/PNET received inductive chemotherapy, surgical treatment, or local irradiation. Furthermore, 8 patients received maintenance chemotherapy, 16 patients received HDCT with auto-HSCT, and 3 patients proceeded to second-line chemotherapy and allo-HSCT. At the time of auto-HSCT 9 patients were in complete remission (CR), and in 7 patients partial response (PR) was achieved. A total of 4 patients with relapse after auto-HSCT (n=1) or primary resistant disease (n=3) received allo-HSCT from matched unrelated (n=2) or haploidentical (n=2) donors after non-myeloablative conditioning.

Results: The EFS for patients with CR at the moment of HDCT with auto-HSCT was significantly better than in patients with PR or on supportive therapy: 0.65, 0.18, and 0.0 respectively (p=0.17). Also there was a significant difference in patients with a prognostic score according to Ladenstein et al. (2010) of 3–5 compared to patients with prognostic score ≥5 (0.5 and 0.0, p=0.19). Patients receiving allo-HSCT developed partial response (shrinkage of target lesions by 50–80%), but progressed after a median of 89 days: 3 patients died of disease progression or GVHD.

Conclusions: HDCT with auto-SCT is effective in patients with CR after inductive therapy. HDCT with allo-HSCT is ineffective as salvage therapy, although there is some clinical evidence of graft-versus-tumor effect. It could be used in patients with PR after inductive therapy or a high initial prognostic score.

Keywords: Ewing sarcoma, PNET, autologous transplantation, high-dose chemotherapy, allogeneic transplantation