The effectiveness of high-dose chemotherapy with autologous hematopoietic stem cell transplantation in the treatment

Autor: T. V. Yukhta, I. V. Kazantsev, A. G. Gevorgyan, P. S. Tolkunova, A. V. Kozlov, D. A. Zvyagintseva, T. V. Andreeva, B. I. Smirnov, E. V. Morozova, S. A. Safonova, Yu. А. Punanov, L. S. Zubarovskaya, B. V. Afanasyev
Jazyk: ruština
Rok vydání: 2019
Předmět:
Zdroj: Онкогематология, Vol 14, Iss 4, Pp 47-58 (2019)
Druh dokumentu: article
ISSN: 1818-8346
2413-4023
DOI: 10.17650/1818-8346-2019-14-4-47-58
Popis: Background. Ewing sarcoma (EWS) is a second most common pediatric bone tumor. About one quarter of all patients belong to a high-risk group characterized by a poor prognosis. In spite of high-dose chemotherapy (HDCT) with autologous hemopoietic stem cell transplantation (auto-HSCT) being traditionally viewed as a possible option for high-risk patients, there is stills no consensus on indications for this method in EWS patients.Study objective: to evaluate the HDCT effectiveness and most important prognostic factors in a prospective cohort of high-risk EWS patients. Materials and methods. A total of 73 EWS patients receiving treatment in R.M. Gorbacheva Memorial Institute were included in the study. All patients were characterized by one or several high-risk features: local (primary tumor volume >200 ml, axial localization, poor response to chemotherapy; n = 55; 76 %), primary disseminated disease (n = 58; 80 %), first chemoresponsive relapse (n = 7; 9 %). All patients received a myeloablative consolidation regimen consisting of busulfan 16mg/kg and melphalan 140mg/m2. In patients with primary disseminated disease an additional evaluation according to risk scale by R. Ladenstein et al. was performed. Based on risk points all patients were stratified as standard (n = 20), high (n = 26), and ultrahigh risk (n = 12).Results. The 5-year overall and event-free survivalfor a whole studied cohort were 40 and 37 %, accordingly. In patients with high-risk localized disease the 5-year overall and event-free survival were 48 and 45 %, accordingly. The HDCT regimen was characterized by acceptable toxicity. The main non-hematologic toxicities were infectious complications (n = 61) and gastrointestinal tract mucositis (n = 31). One patient of 76 died due to treatment-related complications. The multivariate analysis revealed the following risk factors: therapy response (hazard ratio (HR) 2.2; p
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