Results of application of high-dose polychemotherapy with autologous transplantation of hematopoietic stem cells in the treatment of embryonic CNS tumors in children (experience of one center)
Summary. The central nervous system (CNS) tumors remain among the most common malignant neoplasms in children, with the second highest frequency after acute leukemia and the third after acute leukemia and lymphoma in Ukraine. Modern protocols for the treatment of CNS tumors in children under 4 years of age include surgical treatment and courses of intensive polychemotherapy (PCT), in children over 4 years of age — surgery, radiation therapy (local and craniospinal) and PCT supportive by the scheme CCNU/cisplatin/VCR. But despite this, according to the results of the working group of the HIT-2000 protocol, children under 3 years of age have a lower overall survival rate of 5 years of 12–28% compared with the older age group of 55–73%. In order to increase the overall survival of this group of patients, the use of high-dose chemotherapy (НDCT) with autologous transplantation of hematopoietic stem cells (auto-THSC) has been introduced, which allows achieving high concentrations of chemotherapy in the CNS and contributes to the improvement of treatment efficacy. The high efficiency of auto-THSC is established in the treatment of supratentorial primitive neuroectodermal tumors in the first line of therapy or in combination with radiotherapy: overall survival — 40%, survival without progression — 24%, which may be a method of choice in a group of patients with primary disseminated and recurrent hemorrhagic CNS tumors, which are characterized by an unfavorable prognosis, range from 5–30%. In the Department of children’s oncology of the National Cancer Institute 13 patients with CNS tumors have been conducted НDCT with auto-THSC in the period from 2011 to 2017. At present, 7 patients are in remission, 3 patients continue treatment (1 patient for the early relapse of the disease, 2 — the II element of the HDCT with auto-THSC), 2 patients died from the progression of the disease, 1 patient died of complications that arose during the second element of the HDCT. The overall survival rate of patients is 76.9%. Thus, as can be seen from the data presented, conduction of HDCT with auto-THSC is an important stage in the complex treatment in a certain category of patients with CNS tumors and needs further study, which will allow them to significantly increase their overall survival.
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