ISSN 1866-8836
Клеточная терапия и трансплантация

PO-04. Experience in high-dose chemotherapy with autologous hematopoietic stem cell transplantation in children in Chelyabinsk Region

Maria V. Danilova, Sergei G. Kovalenko, Svetlana E. Tsvetkova, Elena V. Kopytova, Karine B. Volkova, Maria V. Bogacheva, Irina I. Spichak

Chelyabinsk Regional Children’s Clinical Hospital, Chelyabinsk, Russia


Contact: Dr. Maria V. Danilova, e-mail: Danilova-m96@mail.ru

doi 10.18620/ctt-1866-8836-2023-12-3-1-176

Summary

Modern high-dose chemotherapy (HDCT) is included into standard treatment protocols for many oncological diseases in children. The use of high doses of anticancer drugs and their combination allows to achieve a more pronounced cytotoxic effect on tumor growth. However, the development of life-threatening myelosuppression is a limiting factor in their usage. In order to reduce the risks of early and late toxicity, improve patient survival and reduce the duration of hospitalization, HDCT is always accompanied by autologous hematopoietic stem cell transplantation (auto-HSCT). Reinfusion of hematopoietic stem cells (HSC) as a part of auto-HSCT provides a rapid recovery of hematopoiesis after HDCT. The objective of our study was to analyse the results of HDCT followed by auto-HSCT in children with malignant neoplasms performed at the Regional V. I.Gerain Oncohematological Center for Children and Adolescents (Chelyabinsk Regional Clinical Children’s Hospital).

Materials and methods

The retrospective study was conducted by the historical-archival method at the Regional V. I.Gerain Oncohematological Center for Children and Adolescents. We analyzed 11 HDCT courses with subsequent auto-HSCT performed from 2021 to 2023 in 10 patients with malignant neoplasms. Toxicity and efficacy of the treatment were assessed taking into account the frequency of infectious complications, early post-transplant mortality, overall survival (OS).

Results

Over the period of 01.01.2021 to 01.08.2023, the group of our patients subjected to HDCT with auto-HSCT included 10 persons. The nosological structure of the studied cohort is diverse. The predominant category of patients were children with neuroblastoma (27.3%) and lymphoma (27.3%); meduloblastoma and Ewing’s sarcoma accounted for 18.2% each; with nephroblastoma (9%). The study of gender characteristics showed that boys predominate: 7 boys (63.6%) and 4 girls (36.4%), the M:F ratio was 1.75:1. The mean age of the patients was 6 years. As a second-line therapy, HDCT was performed in 3 patients, and 7 children received the first-line therapy. In 90% of children, one course of HDCT was performed, and tandem transplantation was performed in 10% of cases, by recommendations of appropriate treatment protocols. The combination of busulfan and melphalan was the most common myeloablative conditioning regimen before auto-HSCT (27.3%). Peripheral stem cells (HSCs) were used as the main source of hematopoietic stem cells (100% of cases). The incidence of infectious complications in the post-transplant period was 100%. Among infectious episodes, the most common were febrile neutropenia (63.6%); mucositis (63.6%), in particular, stomatitis; enteritis, herpes zoster (9.15%). The median platelet recovery time to >100,000/mcL was 34 days (16 to 64), mean time of granulocyte restoration to >500/mcL was 14 days (7 to 22). When analyzing the conducted courses of HDCT followed by auto-HSCT, we did not register any cases of graft-associated death, and there were also no cases of non-engraftment. After completion of the HDCT stage with auto-HSCT, 2 patients (20%) achieved complete remission, 7 patients (70%) continued anticancer therapy, and one patient (10%) received radiation therapy.

Conclusion

Retrospective analysis of HDCT with auto-HSCT in children with malignant neoplasms showed an opportunity of high-quality implementation of technologies in a specialized center. Overall survival rate is estimated at 80%. The results suggest an increased availability of treatment resources for children with cancer.

Keywords

High-dose chemotherapy, hematopoietic stem cell transplantation, autologous, pediatric oncology.


Supplement 12-3
09/30/2023

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doi 10.18620/ctt-1866-8836-2023-12-3-1-176

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