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

• Published in: Pediatric transplantation Vol. 20; no. 2; pp. 284 - 289
• Main Authors: Elborai, Yasser, Hafez, Hanafy, Moussa, Emad A., Hammad, Mahmoud, Hussein, Hany, Lehmann, Leslie, Elhaddad, Alaa
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.03.2016
• Subjects: Adolescent; Antineoplastic Agents - administration & dosage; autologous hematopoietic stem cell transplantation (HSCT); Boston; Brain Neoplasms - drug therapy; Brain Neoplasms - therapy; Busulfan - administration & dosage; busulfan/melphalan (Bu/Mel); carboplatin; Carboplatin - administration & dosage; Child; Child, Preschool; Egypt; etoposide; Etoposide - administration & dosage; Humans; Infant; Infant, Newborn; melphalan (CEM); Melphalan - administration & dosage; neuroblastoma; Neuroblastoma - drug therapy; Neuroblastoma - therapy; renal toxicity; Retrospective Studies; Transplantation Conditioning - methods; Treatment Outcome; renal toxicity; busulfan/melphalan (Bu/Mel); carboplatin; neuroblastoma; autologous hematopoietic stem cell transplantation (HSCT); etoposide; melphalan (CEM)
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.12638

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.