1
|
Kang SH, Kim W, Lee JS, Suh JK, Kim H, Kim DK, Choi SH, Cho HW, Ju HY, Yoo KH, Sung KW, Koo HH, Seo SW, Im HJ, Lee JW, Koh KN. High-dose chemotherapy followed by autologous stem cell transplantation in pediatric patients with relapsed osteosarcoma. Pediatr Blood Cancer 2023; 70:e30233. [PMID: 36751119 DOI: 10.1002/pbc.30233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Patients with relapsed osteosarcoma have poor treatment outcomes. High-dose chemotherapy with autologous stem cell transplantation (HDCT/ASCT) has been used in several high-risk malignant solid tumors; however, few studies have evaluated their role in treating osteosarcoma. We evaluated the effectiveness of HDCT/ASCT in relapsed pediatric osteosarcoma cases. PROCEDURE We retrospectively reviewed the medical records of 40 patients diagnosed with and treated for relapsed osteosarcoma at Asan Medical Center and Samsung Medical Center from January 1996 to July 2019. RESULTS The median age of this cohort was 13.4 years (range: 6.1-18.2). The cohort's 5-year overall survival (OS) was 51.0% ± 0.1% during a median follow-up period of 67.5 months. Twenty-five patients (62.5%) achieved complete remission (CR) with salvage treatment, and the 5-year OS was 82.4% ± 0.1%, whereas none of the remaining 15 patients who did not achieve CR survived (p < .0001). Of the 25 CR cases, 15 underwent subsequent HDCT/ASCT. We compared the effect of HDCT/ASCT among patients who achieved CR. There were no significant differences in the 5-year OS outcomes between patients who did and did not receive HDCT/ASCT (83.9% ± 0.1%, 13/15 vs. 80.0% ± 0.1%, 8/10, respectively; p = .923). CONCLUSION To our knowledge, we report the first comparative cohort study that proved HDCT/ASCT does not significantly improve survival outcomes in relapsed osteosarcoma. Achievement of CR remains the most crucial factor for good survival outcomes.
Collapse
Affiliation(s)
- Sung Han Kang
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Wanlim Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Seok Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Kyung Suh
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Hyery Kim
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Hoon Choi
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Won Cho
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Hee Young Ju
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Sung Wook Seo
- Department of Orthopedic Surgery, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Ho Joon Im
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Won Lee
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Kyung-Nam Koh
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Hong KT, Park HJ, Kim BK, An H, Choi JY, Cheon JE, Park SH, Kim HS, Kang HJ. Favorable outcome of high-dose chemotherapy and autologous hematopoietic stem cell transplantation in patients with nonmetastatic osteosarcoma and low-degree necrosis. Front Oncol 2022; 12:978949. [PMID: 36176408 PMCID: PMC9513349 DOI: 10.3389/fonc.2022.978949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background A low-degree tumor necrosis after neoadjuvant chemotherapy is a poor prognostic factor for osteosarcoma (OSA). However, the role of high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation in OSA remains controversial. We analyzed the treatment outcomes and prognostic factors of nonmetastatic OSA and compared the HDC and conventional chemotherapy (CC) outcomes of patients with <90% necrosis after neoadjuvant chemotherapy. Methods We retrospectively evaluated patients with OSA treated at the Seoul National University Children’s Hospital from 2000 to 2020. Totally, 113 patients with non-metastatic OSA at diagnosis were included. The majority were treated with cisplatin, doxorubicin, and methotrexate as neoadjuvant chemotherapy. This was continued when the postoperative necrosis rate was >90% (good response [GR]), whereas most cases with <90% (poor response [PR]) were changed to chemotherapy. The HDC regimen was composed of melphalan, etoposide, and carboplatin. Results The median age at diagnosis was 12.6 years (range, 5.0–20.3), and 61.9% of patients were men. The 5-year event-free survival (EFS) and overall survival (OS) rates were 75.8% and 91.5%, respectively. Among these, 59 and 44 patients were included in the GR and PR groups, respectively. The GR group had a better 5-year EFS rate than the PR group (82.4% vs. 67.3%, p=0.071). Age at diagnosis, sex, tumor site, type of neoadjuvant chemotherapy, and degree of tumor necrosis were not different between the PR-HDC (n=24) and PR-CC (n=20) groups. The 5-year EFS and OS rates in the PR-HDC (n=24) and PR-CC (n=20) groups were 78.6% and 53.6% (p=0.065) and 100% and 76.9% (p=0.024), respectively. In the Cox regression analysis, the PR-CC group (hazard ratio, 4.95; p=0.004) and age ≥12 years (hazard ratio, 2.68; p=0.024) were significant risk factors for 5-year EFS. Conclusions HDC showed favorable outcomes in patients with non-metastatic OSA and <90% necrosis after neoadjuvant chemotherapy.
Collapse
Affiliation(s)
- Kyung Taek Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, South Korea
| | - Hyun Jin Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, South Korea
| | - Bo Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, South Korea
| | - Hong Yul An
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, South Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, South Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Soo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul, South Korea
- Wide River Institute of Immunology, Hongcheon, South Korea
- *Correspondence: Hyoung Jin Kang,
| |
Collapse
|
3
|
Bordbar M, Sarfaraz A, Haghpanah S, Zekavat O, Zareifar S, Zarei T. The Outcome of Children With Malignant Bone Tumors: A Single-Center Experience. Glob Pediatr Health 2021; 8:2333794X211042238. [PMID: 34471652 PMCID: PMC8404661 DOI: 10.1177/2333794x211042238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/07/2021] [Indexed: 11/24/2022] Open
Abstract
Malignant bone tumors (MBT) account for 3% to 5% of cancers in children younger than 15 years. We aimed to report the outcome of children with MBT in 10 years in Southern Iran. During the study period, 100 patients (57 Osteosarcoma, 43 Ewing sarcoma) with an M/F ratio of 1.56 and a median age of 13.8 years (3.8-17.9) were diagnosed. Metastasis occurred in 27% of patients, mostly in the first 3 months of diagnosis. The mean survival time of MBT altogether was 94.1 months (95% CI: 86.5-101.7). The 5-year overall survival and event-free survivals were 85.2% (95% CI: 74%-91.8%) and 69.2% (95% CI: 56%-79%), respectively. Metastasis was the only independent risk factor of death in our study cohort (Hazard ratio 36.7, 95% CI: 4.8-282.6, P = .001) MBT in children mostly occur in adolescent boys. About one-third of them become metastatic, which is significantly associated with poor outcomes.
Collapse
Affiliation(s)
| | - Ali Sarfaraz
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omidreza Zekavat
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soheila Zareifar
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Zarei
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
4
|
Uemura S, Mori T, Ishiko S, Takafuji S, Nino N, Yamamoto N, Hayakawa A, Nishimura N, Hara H, Kawamoto T, Akisue T, Iijima K. Retrospective analysis of high-dose chemotherapy followed by autologous stem cell transplantation for high-risk pediatric osteosarcoma. Pediatr Hematol Oncol 2020; 37:337-343. [PMID: 32151185 DOI: 10.1080/08880018.2020.1729906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The outcomes of osteosarcoma with poor prognostic factors, such as poor responders, metastatic disease at diagnosis, and relapsed or refractory disease, are poor. We reviewed the clinical records of the patients diagnosed with osteosarcoma at our institute between 2004 and 2018 who received high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) in our institute. Ten patients of osteosarcoma with poor responder, refractory status, and metastatic disease at diagnosis received high-dose chemotherapy followed by ASCT. Four patients underwent high-dose chemotherapy followed by ASCT with the conditioning regimen consisted of thiotepa and melphalan (MEL). Five patients underwent high-dose chemotherapy followed by ASCT with the conditioning regimen consisted of intravenous busulfan (BU) and MEL. One patient underwent tandem high-dose chemotherapy followed by ASCT with BU and MEL followed by carboplatin and etoposide. None of the ten patients died of regimen related toxicities. None of the five patients with poor responders who underwent high-dose chemotherapy followed by ASCT as part of consolidation therapy died of disease after ASCT. High-dose chemotherapy followed by ASCT might be effective for poor responders in osteosarcoma.
Collapse
Affiliation(s)
- Suguru Uemura
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Mori
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Ishiko
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Takafuji
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nanako Nino
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuyuki Yamamoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Hayakawa
- Department of Palliative Medicine, Yodogawa Christian Hospital, Osaka, Japan
| | - Noriyuki Nishimura
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hitomi Hara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Teruya Kawamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Akisue
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
5
|
Bae K, Jeon KN, Choi HS, Song DH, Kim HC. Pulmonary tuberculosis mimicking radiation pneumonitis in a patient with neck malignancy: A case report. Medicine (Baltimore) 2019; 98:e16398. [PMID: 31277197 PMCID: PMC6635133 DOI: 10.1097/md.0000000000016398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Primary or reactivation pulmonary tuberculosis (TB) is frequent in immunocompromised patients such as those with human immunodeficiency virus (HIV) infection, chronic renal failure, poorly controlled diabetes, and hematologic malignancy. Immune system of patients with solid-organ cancer can be also altered by malignancy itself or chemotherapy. However, information on the effect of radiation on patient's immunity is scarce. Herein, we present a case of pulmonary TB occurring in a radiation field that mimics focal radiation pneumonitis in a patient who has received curative chemoradiation therapy for neck malignancy. We also performed literature review to understand the impact of radiation therapy on patients' immunity. PATIENT CONCERN A 56-year-old male patient visited our hospital with a palpable mass in the right supraclavicular fossa which was later confirmed as metastatic squamous cell carcinoma. After completion of concurrent chemoradiation therapy, a focal consolidation was developed in the right upper lobe apex where radiation was applied. The patient did not have any symptoms or signs of infectious disease. DIAGNOSIS Pulmonary TB was diagnosed through polymerase chain reaction (PCR) test and culture of sputum. INTERVENTION Anti-TB medication was started. OUTCOME The patient was tolerable to anti-TB medication and the size of TB lesion gradually decreased. LESSON A suspicion of pulmonary TB should be given to patients with new infiltrates in radiation port due to impact of radiation therapy on local infection barriers and patients' immune system.
Collapse
Affiliation(s)
- Kyungsoo Bae
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju
- Department of Radiology
| | - Kyung Nyeo Jeon
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju
- Department of Radiology
| | - Hoon Sik Choi
- Department of Radiation Oncology, Gyeongsang National University Changwon Hospital, Changwon
| | | | - Ho Cheol Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| |
Collapse
|
6
|
High-dose chemotherapy and autologous stem cell transplantation with melphalan, etoposide and carboplatin for high-risk osteosarcoma. Bone Marrow Transplant 2015; 50:1375-8. [DOI: 10.1038/bmt.2015.145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
LONG XINHUA, ZHONG ZHENHAO, PENG AIFEN, ZHU LIANGBO, WANG HENG, ZHANG GUOMEI, LIU ZHILI. LY294002 suppresses the malignant phenotype and sensitizes osteosarcoma cells to pirarubicin chemotherapy. Mol Med Rep 2014; 10:2967-72. [DOI: 10.3892/mmr.2014.2617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 05/19/2014] [Indexed: 11/05/2022] Open
|
8
|
Boye K, Del Prever AB, Eriksson M, Saeter G, Tienghi A, Lindholm P, Fagioli F, Skjeldal S, Ferrari S, Hall KS. High-dose chemotherapy with stem cell rescue in the primary treatment of metastatic and pelvic osteosarcoma: final results of the ISG/SSG II study. Pediatr Blood Cancer 2014; 61:840-5. [PMID: 24254749 DOI: 10.1002/pbc.24868] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/29/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with metastatic osteosarcoma at diagnosis or axial primary tumors have a poor prognosis. The aim of the study was to evaluate the feasibility and efficacy of intensified treatment with high-dose chemotherapy (HDCT) and stem cell rescue in this group. METHODS From May 1996 to August 2004, 71 patients were included in a Scandinavian-Italian single arm phase II study. Preoperative chemotherapy included methotrexate, doxorubicin, cisplatin and ifosfamide, and postoperative treatment consisted of two cycles of doxorubicin, one cycle of cyclophosphamide and etoposide and two courses of high-dose etoposide and carboplatin with stem cell rescue. RESULTS Twenty-nine patients (43%) received two courses and 10 patients (15%) received one course of HDCT. HDCT was associated with significant toxicity, but no treatment-related deaths were recorded. Fourteen patients (20%) had disease progression before completion of the study protocol, and only 29/71 patients (41%) received the full planned treatment. Median event-free survival (EFS) was 18 months, and estimated 5-year EFS was 27%. Median overall survival (OS) was 34 months, and estimated 5-year OS was 31%. When patients who did not receive HDCT due to disease progression were excluded, there was no difference in EFS (P = 0.72) or OS (P = 0.49) between patients who did or did not receive HDCT. CONCLUSIONS The administration of high-dose chemotherapy with stem cell rescue was feasible, but associated with significant toxicity. Patient outcome seemed comparable to previous studies using conventional chemotherapy. We conclude that HDCT with carboplatin and etoposide should not be further explored as a treatment strategy in high-risk osteosarcoma.
Collapse
Affiliation(s)
- Kjetil Boye
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Vargas AO, Luna RR, Garcia MP, Cardos RC, Hidalgo LV, Jácome DL, Gutiérrez MC. Consolidation treatment for high risk solid tumors in children with myeloablative chemotherapy and autologous hematopoietic progenitor stem cell transplantation. Rev Bras Hematol Hemoter 2013; 35:343-6. [PMID: 24255618 PMCID: PMC3832315 DOI: 10.5581/1516-8484.20130099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 07/20/2013] [Indexed: 12/01/2022] Open
Abstract
Background In childhood cancer, consolidation treatment with chemotherapy followed by
autologous hematopoietic progenitor stem cell transplantation is currently an
accepted treatment modality in patients with high-risk solid tumors or in patients
who have relapsed after conventional treatment. Objectives The objective of this study was to describe the results of transplantation of a
group of children who had high-risk solid tumors or relapsed after conventional
chemotherapy regimens. Methods A retrospective analysis was conducted from January 1998 to October 2004 of all
children with pathologic diagnoses of high-risk solid tumors or children that had
previously relapsed after conventional chemotherapy and that were subsequently
submitted to autologous hematopoietic progenitor stem cell transplantation. The
analysis included overall survival rates, event-free survival rates, mortality
rates and chemotherapy complications. Results Nineteen patients were submitted to this approach. The age range was from 27 to
196 months with a median age of 52 months. The overall survival rate at 100 days
was observed in 79%, the three-year event-free survival rate was 63%. The
mortality rate secondary to the myeloablative chemotherapy regimen was 21% (n =
4). Only three patients (15.8%) relapsed with tumor progression after transplant.
Conclusion Autologous hematopoietic progenitor stem cell transplantation is still a
successful procedure in patients with solid tumors refractory to conventional
chemotherapy.
Collapse
|
10
|
Moore C, Eslin D, Levy A, Roberson J, Giusti V, Sutphin R. Prognostic significance of early lymphocyte recovery in pediatric osteosarcoma. Pediatr Blood Cancer 2010; 55:1096-102. [PMID: 20734401 DOI: 10.1002/pbc.22673] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Evidence suggests early lymphocyte recovery after chemotherapy predicts superior outcome for patients with cancer, a phenomenon not previously investigated in osteosarcoma. This study determined the prognostic significance of early lymphocyte recovery for pediatric patients with osteosarcoma. PROCEDURES We reviewed data of 19 consecutive patients treated for osteosarcoma at our institution from 1997 to 2007. After initial chemotherapy, patients were separated into two groups: early versus late lymphocyte recovery, using a threshold absolute lymphocyte count of ≥ 800 cells/µl on day 14 (ALC-14). RESULTS The 5-year overall survival (OS) for our cohort was 73.7% [± 10.1 standard error (SE)]. Thirteen patients (68%) had an ALC-14 ≥ 800 cells/µl, with 12/13 alive and 5-year OS of 92.3% (± 7.4 SE). In contrast, six patients (32%) had an ALC-14 < 800 cells/µL, with 1/6 alive and 5-year OS of 33.3% (± 19.2 SE). The difference is statistically significant (P = 0.0013, log-rank test). Two patients presented with multifocal disease at diagnosis, had late lymphocyte recovery and died. One patient presented with metastatic disease, had early lymphocyte recovery and is alive. Six patients developed relapsed disease with a 5-year OS of 33.3% (± 19.2 SE). The majority (5/6) of patients with relapsed disease died while on active therapy. The only survivor in this group had an ALC-14 > 800 cells/µl and recently completed relapse therapy. CONCLUSIONS These data demonstrate that early lymphocyte recovery represents a significant prognostic indicator for osteosarcoma. Early identification and risk stratification therapy based on the ALC-14 threshold may improve outcomes and our knowledge of this disease.
Collapse
Affiliation(s)
- Colin Moore
- Department of Pediatric Medical Education, Arnold Palmer Medical Center, Orlando Health, Orlando, Florida, USA
| | | | | | | | | | | |
Collapse
|
11
|
Kawano M, Nishida H, Nakamoto Y, Tsumura H, Tsuchiya H. Cryoimmunologic antitumor effects enhanced by dendritic cells in osteosarcoma. Clin Orthop Relat Res 2010; 468:1373-83. [PMID: 20232181 PMCID: PMC2853649 DOI: 10.1007/s11999-010-1302-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 03/01/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND We previously reported a limb-salvage technique by treating tumor-bearing bone with liquid nitrogen. We also reported systemic antitumor immunity was enhanced by cryotreatment in a murine osteosarcoma (LM8) model. We therefore combined the cryotreatment of tumor with dendritic cells to promote tumor-specific immune responses. QUESTIONS/PURPOSES We determined whether our technique could enhance systemic immune response and inhibit metastatic tumor growth in a murine osteosarcoma model. MATERIALS AND METHODS To evaluate activation of the immune response, we prepared six groups of C3H mice (80 mice total): (1) excision only, (2) dendritic cells without reimplantation of the cryotreated primary tumor, (3) reimplantation of the cryotreated primary tumor alone, (4) dendritic cells combined with reimplantation of the cryotreated primary tumor, (5) dendritic cells exposed to cryotreated tumor lysates without reimplantation of the cryotreated primary tumor, and (6) dendritic cells exposed to cryotreated tumor lysates with reimplantation of the cryotreated primary tumor. We then compared and verified the activation state of each group's antitumor immunity. RESULTS Mice that received dendritic cells exposed to cryotreated tumor lysates with reimplantation of the cryotreated primary tumor group had high serum interferon gamma, reduced pulmonary metastases, and increased numbers of CD8(+) T lymphocytes in the metastatic areas. CONCLUSIONS Combining tumor cryotreatment with dendritic cells enhanced systemic immune responses and inhibited metastatic tumor growth. CLINICAL RELEVANCE We suggest immunotherapy could be developed further to improve the treatment of osteosarcoma.
Collapse
Affiliation(s)
- Masanori Kawano
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
- Department of Orthopaedics Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hideji Nishida
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Yasunari Nakamoto
- Department of Gastroenterology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedics Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| |
Collapse
|