High-dose treatment for malignant rhabdoid tumor of the kidney: No evidence for improved survivalThe Gesellschaft fur Padiatrische Onkologie und Hamatologie (GPOH) experience

Furtwaengler, Rhoikos; Kager, Leo; Melchior, Patrick; Ruebe, Christian; Ebinger, Martin; Nourkami-Tutdibi, Nasenien; Niggli, Felix; Warmann, Steven; Hubertus, Jochen; Amman, Gabriele; Leuschner, Ivo; Vokuhl, Christian; Graf, Norbert und Fruehwald, Michael C. (2018): High-dose treatment for malignant rhabdoid tumor of the kidney: No evidence for improved survivalThe Gesellschaft fur Padiatrische Onkologie und Hamatologie (GPOH) experience. In: Pediatric Blood & Cancer, Bd. 65, Nr. 1, e26746

Abstract

Background: Malignant rhabdoid tumor of the kidney (MRTK) is the most aggressive childhood renal tumor with overall survival (OS) rates ranging from 22% to 42%. Whether high-dose chemotherapy with autologous stem-cell transplantation (HDSCT) in an intensive first-line treatment offers additional benefit is an ongoing discussion. Methods: A retrospective analysis of all 58 patients with MRTK from Austria, Switzerland, and Germany treated in the framework of consecutive, prospective renal/rhabdoid tumor studies SIOP9/GPO, SIOP93-01/GPOH (where SIOP is International Society of Pediatric Oncology and GPOH is German Society of Pediatric Oncology and Hematology), SIOP2001/GPOH, and European Rhabdoid Tumor Registry from 1991 to 2014. Results: Median age at diagnosis was 11 months. Fifty percent of patients had metastases or multifocal disease at diagnosis (Stage IV). Local stage distribution was as follows: not done/I/II/III1/6/11/40. Fifteen (26%) patients underwent upfront surgery. Thirty-seven (64%) patients achieved a complete remission, 17 (29%) relapsed, 34 (59%) died of disease progression, and two (3%) died of treatment-related complication. Mean time to the first event was 3.5 months. Two-year EFS/OS (where EFS is event-free survival) for the whole group was 376%/38 +/- 6%. Metastases/multifocal disease, younger age, and local stage III were associated with significantly inferior survival. Eleven (19%) patients underwent HDSCT (carboplatin+thiotepa, n = 6;carboplatin+etoposide+melphalan, n = 4;others, n = 1);2-year OS in this group was 60 +/- 15% compared to 34 +/- 8% in the non-HDSCT group (P = 0.064). However, the time needed from radiologic to histologic diagnosis, stem-cell harvest, and HDSCT must also be taken into account to avoid selection bias by excluding the highest risk group with early progression (<90 days). Thus, 2-year EFS only for patients without progression until day 90 was 60 +/- 16% consolidated by HDSCT compared to 62 +/- 11% without (P = 0.8). Conclusion: Our retrospective analysis suggests comparable outcomes for patients with and without HDSCT, if adjusted for early disease progression.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1545-5009
• Sprache: Englisch