고위험군 소아 신경모세포종에서의 말초혈액 자가 조혈모세포 이식술을 동반한 고용량 화학요법

Abstract

Background: High dose chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT) has become standard therapy for high-risk neuroblastoma patients. We performed a retrospective analysis to assess the characteristics of peripheral blood stem cell harvest (PBSCH) and PBSCT and its clinical outcome.Methods: We reviewed 17 cases of patients with high-risk neuroblastoma that underwent PBSCH and/or high dose chemotherapy followed by PBSCT.Results: Sixteen patients had stage IV neuroblastoma and one patient had a stage III neuroblastoma with MYCN amplification. The median age of the 17 patients was 43 months (range 22∼114 months) and the median body weight was 15 kg (range 10∼24 kg). After induction chemotherapy using a modified N7 protocol, 34 PBSCHs (1.5 leukapheresis per PBSCH) were performed. A statistically significant correlation was found between the pre-leukapheresis CD34+ cell count and the total number CD34+ cells of the harvested products (P＜0.0001). Tyrosine hydroxylase mRNA was not detected by RT-PCR in all of the leukapheresis products. High dose chemotherapy followed by PBSCT was performed in 24 cases. The mean infused CD34+ cell dose was 4.01×106/kg and WBC and platelet engraftment was performed on day 12.0 and 21.5, respectively. Eleven patients died, and six patients are surviving 11 to 68 months after PBSCT (median survival time, 35 months).Conclusion: In this single institution study, treatment with high dose chemotherapy and PBSCT was performed successfully for children with high-risk neuroblastoma.