Purpose: To assess the outcome of patients with refractory or relapsed solid tumors treated with myeloablative chemotherapy followed by autologous peripheral blood stem cell transplantation.
Patients and methods: From October 1997 to March 2006, 38 transplantations were performed in 32 patients (19 children and 13 adults, 20 men and 12 women, median age 18.5 years, range 3 - 59). Six patients underwent 2 transplantations. The diagnoses were: rhabdomyosarcoma-4; Ewing's sarcoma -7; lymphoepithelioma epipharyngis -7; germ-cell tumors -6; neuroblastoma -4; pulmonary blastoma -1; breast cancer -3. The indication for high-dose chemotherapy was sensitive relapse in 17 and refractory disease in 15 patients. At the time of transplantation the state of remission was: complete remission (CR) in 10 patients; partial remission (PR) in 16 and disease progression in 6. The median number of transplanted CD34+ cells was 4.49 x 10(6)/kg of patient's body weight. High-dose chemotherapy regimens were: thiotepa, carboplatin - 1; thiotepa, cyclophosphamide - 5; ifosfamide, carboplatin, etoposide (ICE) - 18; etoposide, carboplatin - 2; etoposide, cyclophosphamide, melphalan - 2; melphalan, fludarabine - 1; melphalan, busulfan - 3; etoposide, carboplatin, ifosfamide/thiotepa, cyclophosphamide (EBDIS) - 4.
Results: Twenty-nine patients were engrafted and 3 died from graft failure. Transplantation-related mortality was 9%. The most important transplantation-related toxicities included mucositis (90% of the patients), fever (85%) and diarrhea (75%). With a median follow-up of 32 months (range 1-95), the median overall survival (OS) and the event-free survival (EFS) were 62 and 36 months, respectively.
Conclusion: High-dose chemotherapy with autologous stem cell transplantation was curative for many of our patients with poor-prognosis solid tumors.