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Mora J. Autologous Stem-Cell Transplantation for High-Risk Neuroblastoma: Historical and Critical Review. Cancers (Basel) 2022; 14:cancers14112572. [PMID: 35681553 PMCID: PMC9179268 DOI: 10.3390/cancers14112572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The original idea that providing higher doses of cytotoxic agents will result in higher rates of tumor cell killing was proposed in the 1980s. Preclinical data supported clinical testing. Advancements in bone marrow and peripheral stem-cell support technologies during the 1980s and 1990s allowed for clinical developments that permitted testing the higher dose hypothesis in oncology patients. The results of almost 20 years of clinical trials proved the linear relationship between dosing and clinical outcome to be mostly inaccurate. As a consequence, the adult oncology field abandoned high-dose chemotherapy strategies by the turn of the 21st century. Neuroblastoma is the only pediatric extracranial solid tumor where high-dose chemotherapy has remained part of the standard management for high-risk cases. This systematic review aims to understand the historical reason for such an exception and analyzes data challenging the benefit of high-dose chemotherapy and autologous stem-cell transplants in the era of anti-GD2 immunotherapy. Abstract Curing high-risk neuroblastoma (HR-NB) is a challenging endeavor, which involves the optimal application of several therapeutic modalities. Treatment intensity for cancer became highly appealing in the 1990s. Investigative trials assumed that tumor response correlated with the dosage or intensity of drug(s) administered, and that this response would translate into improved survival. It was postulated that, if myelotoxicity could be reversed by stem-cell rescue, cure might be possible by increasing the dose intensity of treatment. The principle supported autologous stem-cell transplant (ASCT) strategies. High-dose therapy transformed clinical practice, legislation, and public health policy, and it drove a two-decade period of entrepreneurial oncology. However, today, no ASCT strategies remain for any solid tumor indication in adults. As with most solid malignancies, higher dosing of cytotoxic agents has not resulted in a clear benefit in survival for HR-NB patients, whereas the long-term toxicity has been well defined. Fortunately, novel approaches such as anti-GD2 immunotherapy have demonstrated a significant survival benefit with a much less adverse impact on the patient’s wellbeing. On the basis of extensive experience, persisting with administering myeloablative chemotherapy as the standard to treat children with HR-NB is not consistent with the overall aim in pediatric oncology of curing with as little toxicity as possible.
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Affiliation(s)
- Jaume Mora
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
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Cabanillas Stanchi KM, Willier S, Vek J, Schlegel P, Queudeville M, Rieflin N, Klaus V, Gansel M, Rupprecht JV, Flaadt T, Binder V, Feuchtinger T, Lang P, Handgretinger R, Döring M. Antiemetic Prophylaxis with Fosaprepitant and 5-HT 3-Receptor Antagonists in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:3915-3927. [PMID: 33061297 PMCID: PMC7524181 DOI: 10.2147/dddt.s260887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/21/2020] [Indexed: 02/03/2023]
Abstract
Background High-dose myeloablative conditioning prior to autologous hematopoietic stem cell transplantation (autoHSCT) in pediatric patients is usually highly emetogenic. The antiemetic neurokinin-1 receptor antagonist fosaprepitant was safe and effective in children receiving highly emetogenic chemotherapy. Data on fosaprepitant during autoHSCT in children are currently not available. Methods A total of 35 consecutive pediatric patients, who received an antiemetic prophylaxis with fosaprepitant (4 mg/kg; single dose, max. 1 x 150 mg/kg BW) and ondansetron (24-hours continuous infusion; 8–32 mg/24h) or granisetron (2 x 40 µg/kg∙d−1) during highly emetogenic conditioning chemotherapy before autoHSCT were retrospectively analyzed, and their results were compared with a control group comprising 35 consecutive pediatric patients, who received granisetron or ondansetron only. The antiemetic efficacy and the safety of the two prophylaxis regimens were compared with respect to three time periods after the first chemotherapy administration (0–24h, >24–120h, >120–240h). Results Clinical adverse events and clinically relevant increases/decreases of laboratory markers were similarly low and did not significantly differ between the two study groups (p>0.05). The registered number of vomiting events was significantly higher in the control group in the time periods of 0–24h (64 vs 22 events; p<0.01), >24–120h (135 vs 78 events; p<0.0001), >120–240h (268 vs 105 events; p<0.0001), and the whole observation period 0–240h (467 vs 205 events; p<0.0001). The percentage of patients experiencing vomiting was higher in the control group during the time period of >24–120h (100% vs 74.3%) but not the other analyzed time periods (p>0.05). Conclusion The fosaprepitant-based antiemetic prophylaxis was safe, well tolerated and significantly reduced vomiting in children undergoing highly emetogenic chemotherapy prior to autoHSCT. Prospective randomized trials are necessary to confirm these results.
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Affiliation(s)
| | - Semjon Willier
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. Von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Julia Vek
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Patrick Schlegel
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Manon Queudeville
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Nora Rieflin
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Veronika Klaus
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Melanie Gansel
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Joachim Vincent Rupprecht
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Tim Flaadt
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Vera Binder
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. Von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Tobias Feuchtinger
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. Von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Peter Lang
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Rupert Handgretinger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Michaela Döring
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
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Heilig CE, Badoglio M, Labopin M, Fröhling S, Secondino S, Heinz J, Nicolas-Virelizier E, Blaise D, Korenbaum C, Santoro A, Verbeek M, Krüger W, Siena S, Passweg JR, Di Nicola M, Rifón J, Dreger P, Koehl U, Chabannon C, Pedrazzoli P. Haematopoietic stem cell transplantation in adult soft-tissue sarcoma: an analysis from the European Society for Blood and Marrow Transplantation. ESMO Open 2020; 5:e000860. [PMID: 33097652 PMCID: PMC7590345 DOI: 10.1136/esmoopen-2020-000860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The role of high-dose chemotherapy with autologous stem cell transplantation (ASCT) in the treatment of soft-tissue sarcoma (STS) remains an unsettled issue. Prospective clinical trials failed to prove a benefit of the procedure but were limited by small and heterogeneous patient cohorts. Thus, it is unknown if ASCT may be a valuable treatment option in specific patient subgroups. METHODS The purpose of this study was to investigate the value of ASCT according to histological subtype in STS patients who were registered in the European Society for Blood and Marrow Transplantation database between 1996 and 2016. RESULTS Median progression-free (PFS) and overall survival (OS) in the entire cohort of 338 patients were 8.3 and 19.8 months, respectively, and PFS and OS at 5 years were 13% and 25%, respectively. Analysis of outcomes in different subgroups showed that younger age, better remission status before transplantation and melphalan-based preparative regimen were predictive of benefit from ASCT, whereas histology and grading had no statistically significant impact. CONCLUSIONS Outcomes after ASCT compared favorably to those of recent trials on conventional chemotherapies and targeted therapies in STS, including histology-tailored approaches. ASCT, thus, should be reinvestigated in clinical trials focusing on defined patient subgroups.
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Affiliation(s)
- Christoph E Heilig
- Department of Translational Medical Oncology (TMO), National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Baden-Württemberg, Germany; Department of Medicine V, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany.
| | - Manuela Badoglio
- EBMT Paris study office, Department of Haematology, Hospital Saint-Antoine, Paris, Île-de-France, France
| | - Myriam Labopin
- Saint Antoine Hospital, Université Pierre et Marie Curie, Paris, Île-de-France, France
| | - Stefan Fröhling
- Department of Translational Medical Oncology (TMO), National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Baden-Württemberg, Germany
| | - Simona Secondino
- Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy
| | - Jürgen Heinz
- Medicine I, University Medical Center Freiburg, Freiburg, Baden-Württemberg, Germany
| | | | - Didier Blaise
- Institut Paoli Calmettes, Departement D'Hematologie, Centre de Recherche en Cancerologie de Marseille, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Clément Korenbaum
- Medical Oncology and Cellular Therapy, Hospital Tenon Medical Oncology, Paris, Île-de-France, France
| | - Armando Santoro
- Department of Oncology-Haematology, Humanitas Cancer Center, IRCCS, Milan, Italy
| | - Mareike Verbeek
- Internal Medicine III, Technical University of Munich, Munchen, Bayern, Germany
| | - William Krüger
- Haematology/Oncology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
| | - Jakob R Passweg
- Division of Hematology, University Hospital Basel, Basel, BS, Switzerland
| | - Massimo Di Nicola
- Unit of Immunotherapy and Innovative Therapeutics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Jose Rifón
- Hematology Service and Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Peter Dreger
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Ulrike Koehl
- Institute of Clinical Immunology, Fraunhofer Institute for Cell Therapy and Immunology IZI, Leipzig, Sachsen, Germany; Institute of Cellular Therapeutics, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Christian Chabannon
- Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Inserm CBT-1409, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Paolo Pedrazzoli
- Internal Medicine and Medical Therapy, Università degli Studi di Pavia, Pavia, Lombardia, Italy
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Abstract
AbstractReview articles are an often neglected genre in scholarly communication. Though there was intense discussion about review articles in scientometrics in the 1970s and 1980s, we find less studies devoted to this genre within the last 20 years. Yet, recent discussions in other fields, such as linguistics, sociology or medicine imply that review articles are part of important debates about problems of research in academia, such as research quality or transparency. Against that background, the purpose of this paper is to review recent developments for the study of review articles in scientometrics and beyond, to discuss theoretical, conceptual and empirical accounts of how review articles can be defined, and to identify major methodological and conceptual challenges for studying review articles. Based on reviewing work and inputs received from of a workshop conducted at a Conference of the International Society of Informetrics in September 2019, we propose a research agenda for the study of review articles. We have identified six realms of study in this area: (1) the study of methodological caveats resulting from the usage of scholarly databases, (2) the study of field specific patterns of reception and usage of review articles, (3) the study of argumentative and textual structures of review articles, (4) the exploration of organizations and infrastructures for review articles, (5) the study of epistemic roles of review articles, and (6) the analysis of authorship patterns in review articles.
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