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Allogeneic stem cell transplantation for patients with advanced rhabdomyosarcoma: a retrospective assessment
Authors:U Thiel  E Koscielniak  F Blaeschke  T G P Grunewald  M Badoglio  M A Diaz  C Paillard  A Prete  M Ussowicz  P Lang  F Fagioli  P Lutz  G Ehninger  P Schneider  A Santucci  P Bader  B Gruhn  M Faraci  P Antunovic  J Styczynski  W H Krüger  L Castagna  P Rohrlich  M Ouachée-Chardin  A Salmon  C Peters  M Bregni  S Burdach  On behalf of the Solid Tumour Working Party and the Paediatric Disease Working Party of the European Group for Blood and Marrow Transplantation
Abstract:

Background:

Allogeneic haematopoietic stem cell transplantation (allo-SCT) may provide donor cytotoxic T cell-/NK cell-mediated disease control in patients with rhabdomyosarcoma (RMS). However, little is known about the prevalence of graft-vs-RMS effects and only a few case experiences have been reported.

Methods:

We evaluated allo-SCT outcomes of 30 European Group for Blood and Marrow Transplantation (EBMT)-registered patients with advanced RMS regarding toxicity, progression-free survival (PFS) and overall survival (OS) after allo-SCT. Twenty patients were conditioned with reduced intensity and ten with high-dose chemotherapy. Twenty-three patients were transplanted with HLA-matched and seven with HLA-mismatched grafts. Three patients additionally received donor lymphocyte infusions (DLIs). Median follow-up was 9 months.

Results:

Three-year OS was 20% (s.e.±8%) with a median survival time of 12 months. Cumulative risk of progression was 67% (s.e.±10%) and 11% (s.e.±6%) for death of complications. Thirteen patients developed acute graft-vs-host disease (GvHD) and five developed chronic GvHD. Eighteen patients died of disease and four of complications. Eight patients survived in complete remission (CR) (median: 44 months). No patients with residual disease before allo-SCT were converted to CR.

Conclusion:

The use of allo-SCT in patients with advanced RMS is currently experimental. In a subset of patients, it may constitute a valuable approach for consolidating CR, but this needs to be validated in prospective trials.
Keywords:rhabdomyosarcoma  allogeneic haematopoietic stem cell transplantation  graft-vs-tumour effect  reduced intensity conditioning  myeloablative conditioning  donor lymphocyte infusion
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