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Role of High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation for Children and Young Adults with Relapsed Ewing's Sarcoma: A Systematic Review. Sarcoma 2018; 2018:2640674. [PMID: 29973774 PMCID: PMC6008812 DOI: 10.1155/2018/2640674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/24/2018] [Accepted: 05/13/2018] [Indexed: 12/27/2022] Open
Abstract
Background Relapsed Ewing's sarcoma (RES) is an aggressive malignancy with poor survival. Although high-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) given after conventional chemotherapy (CC) has shown survival benefits, it is not generally used in the United States for RES. We performed a systemic review to evaluate the benefits of HDCT for RES. Methods Literature search involved Medline, Embase, and Cochrane database. We included studies with RES patients treated with HDCT/ASCT. Results Twenty-four studies with total of 345 reported RES patients that got HDCT were included in final analysis. Seventeen studies had patients with multiple malignancies including RES, while seven had only RES patients. At 2 and 3–5 years, event-free survival (EFS) in studies with only RES patients ranged 42–47% and 20–61% and overall survival (OS) ranged 50–66% and 33–77%, respectively. In studies with combined patients that reported outcomes of RES separately, the EFS at 1–3 and 4 years was 36–66% and 17–50%, respectively. The OS at 1-2 and 3-4 years was 40–60% and 50–70%. Conclusions Most studies using HDCT/ASCT as consolidation regimen showed improved survival benefits compared to CC. Randomized controlled studies are needed to determine true clinical benefits of HDCT followed by ASCT in patients with RES.
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Thiel U, Wawer A, von Luettichau I, Bender HU, Blaeschke F, Grunewald TGP, Steinborn M, Röper B, Bonig H, Klingebiel T, Bader P, Koscielniak E, Paulussen M, Dirksen U, Juergens H, Kolb HJ, Burdach SEG. Bone marrow involvement identifies a subgroup of advanced Ewing sarcoma patients with fatal outcome irrespective of therapy in contrast to curable patients with multiple bone metastases but unaffected marrow. Oncotarget 2018; 7:70959-70968. [PMID: 27486822 PMCID: PMC5342601 DOI: 10.18632/oncotarget.10938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/30/2016] [Indexed: 12/21/2022] Open
Abstract
Purpose Advanced Ewing sarcomas have poor prognosis. They are defined by early relapse (<24 months after diagnosis) and/or by metastasis to multiple bones or bone marrow (BM). We analyzed risk factors, toxicity and survival in advanced Ewing sarcoma patients treated with the MetaEICESS vs. EICESS92 protocols. Design Of 44 patients, 18 patients were enrolled into two subsequent MetaEICESS protocols between 1992 and 2014, and compared to outcomes of 26 advanced Ewing sarcoma patients treated with EICESS 1992 between 1992 and 1996. MetaEICESS 1992 consisted of induction chemotherapy, whole body imaging directed radiotherapy to the primary tumor and metastases, tandem high-dose chemotherapy and autologous rescue. In MetaEICESS 2007 this treatment was complemented by allogeneic stem cell transplantation. EICESS 1992 comprised induction chemotherapy, local therapy to the primary tumor only followed by consolidation chemotherapy. Results In MetaEICESS 8/18 patients survived in complete remission vs. 2/26 in EICESS 1992 (p<0.05). Survival did not differ between MetaEICESS 2007 and MetaEICESS 1992. Three MetaEICESS patients died of complications, all in MetaEICESS 1992. After exclusion of patients succumbing to treatment related complications (n=3), 7/10 patients survived without BM involvement, in contrast to 0/5 patients with BM involvement. This was confirmed in a multivariate analysis. There was no correlation between BM involvement and the number of metastases at diagnosis. Conclusion The MetaEICESS protocols yield long-term disease-free survival in patients with advanced Ewing sarcoma. Allogeneic stem cell transplantation was not associated with increased death of complications. Bone marrow involvement is a risk factor distinct from multiple bone metastases.
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Affiliation(s)
- Uwe Thiel
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Angela Wawer
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Irene von Luettichau
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hans-Ulrich Bender
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Franziska Blaeschke
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas G P Grunewald
- Laboratory for Pediatric Sarcoma Biology, Institute of Pathology, LMU, Munich, Germany
| | - Marc Steinborn
- Department of Radiology, Klinikum Schwabing, Städtisches Klinikum München, Munich, Germany
| | - Barbara Röper
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Munich Comprehensive Cancer Center, München, Germany
| | - Halvard Bonig
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany.,Department of Transfusion Medicine and Immunohematology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Thomas Klingebiel
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Peter Bader
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Ewa Koscielniak
- Department of Pediatric Oncology, Hematology and Immunology, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Michael Paulussen
- Vestische Kinder- und Jugendklinik, Datteln, Universität Witten/Herdecke, Datteln, Germany
| | - Uta Dirksen
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Münster, Münster, Germany
| | - Heribert Juergens
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Münster, Münster, Germany
| | - Hans-Jochem Kolb
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan E G Burdach
- Department of Pediatrics and Pediatric Oncology Center, Kinderklinik München Schwabing, Städtisches Klinikum München und Klinikum rechts der Isar, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Munich Comprehensive Cancer Center, München, Germany
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Kriegsmann K, Heilig C, Cremer M, Novotny P, Kriegsmann M, Bruckner T, Müller-Tidow C, Egerer G, Wuchter P. Successful collection of peripheral blood stem cells upon VIDE chemomobilization in sarcoma patients. Eur J Haematol 2017; 99:459-464. [DOI: 10.1111/ejh.12960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 02/05/2023]
Affiliation(s)
| | - Christoph Heilig
- Department of Medicine V; Heidelberg University; Heidelberg Germany
| | - Martin Cremer
- Department of Medicine V; Heidelberg University; Heidelberg Germany
| | - Philipp Novotny
- Department of Medicine V; Heidelberg University; Heidelberg Germany
| | - Mark Kriegsmann
- Institute of Pathology; Heidelberg University; Heidelberg Germany
| | - Thomas Bruckner
- Institute of Medical Biometry und Informatics; Heidelberg University; Heidelberg Germany
| | | | - Gerlinde Egerer
- Department of Medicine V; Heidelberg University; Heidelberg Germany
| | - Patrick Wuchter
- Department of Medicine V; Heidelberg University; Heidelberg Germany
- Institute of Transfusion Medicine and Immunology; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
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Arndt CAS, Rose PS, Folpe AL, Laack NN. Common musculoskeletal tumors of childhood and adolescence. Mayo Clin Proc 2012; 87:475-87. [PMID: 22560526 PMCID: PMC3538469 DOI: 10.1016/j.mayocp.2012.01.015] [Citation(s) in RCA: 207] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/07/2012] [Accepted: 01/16/2012] [Indexed: 11/23/2022]
Abstract
Osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma are the most common malignant musculoskeletal tumors in children and adolescents. Today, most patients can be cured. Numerous factors have contributed to improved outcome for these patients over the past several decades. These include multidisciplinary care involving oncologists, radiation oncologists, surgeons, pathologists, and radiologists and enrollment of patients in clinical trials. Better understanding of molecular mechanisms of disease have resulted in studies using molecular targets in addition to standard chemotherapeutic agents, which hopefully will lead to better outcomes in the future. Moreover, new orthopedic techniques and devices as well as new technologies in radiation oncology hold promise for better local control of primary tumors and the potential for fewer late adverse effects. Despite this progress, patients must undergo lifelong follow-up for possible late effects of intense chemotherapy and radiation therapy. We review the diagnosis, prognosis, staging, multidisciplinary therapy, new directions in therapy, and long-term complications of treatment for these tumors. For this review, we searched MEDLINE using the terms rhabdomyosarcoma, osteosarcoma, Ewing sarcoma, biology, and humans and limited the search to articles from 2000 to September 2011. Additional references found in these articles were utilized as appropriate, as well as references from the background information in current therapeutic studies of the Children's Oncology Group. The same database and time frame were searched for articles written by leading authorities in the field.
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Key Words
- arms, alveolar rhabdomyosarcoma
- cog, children's oncology group
- efs, event-free survival
- erms, embryonal rhabdomyosarcoma
- es, ewing sarcoma
- fdg-pet, fluorodeoxyglucose positron emission tomography
- ie, ifosfamide and etoposide
- map, methotrexate, doxorubicin (adriamycin), and cisplatin
- os, osteosarcoma
- pnet, primitive neuroectodermal tumor
- rms, rhabdomyosarcoma
- vdc, vincristine, doxorubicin, and cyclophosphamide
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Affiliation(s)
- Carola A S Arndt
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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