Autologous peripheral blood cell transplantation in the treatment of advanced neuroblastoma

We review the experience with autologous peripheral blood cell transplantation (APBCT) in children with neuroblastoma at the University of Minnesota.

Aspects of peripheral blood cell collection and use in nine patients who had advanced neuroblastoma (eight Evans stage IV, 1 stage III), who were median age 4 years (range 10 months-22 years) and who were treated with high-dose chemotherapy without total body irradiation and APBCT between September 1987 and December 1989 are reviewed.

A median of 4.8 x 10(8) (range 3.3-8.9) mononuclear cells per kilogram of body weight were obtained by a median of six (range four-eight) collections. In vitro assay of granulocyte-monocyte colony-forming cells (CFU-GM) demonstrated a median of 3.6 x 10(4) (range 0.7-7.8) CFU-GM/kg of body weight. After APBCT, granulocyte recovery (absolute neutrophil count > 500 x 10(6)/L) occurred at a median of 28 days (range 14-72) and platelet recovery (> 150 x 10(9)/L) occurred at a median of 34 days (range 19-202). All patients but one, who had progressive disease, were transplanted with residual disease. Immunocytological analysis of peripheral blood stem cell harvest showed the presence of circulating neuroblastoma cells in three of nine patients, all of whom had minimal marrow residual disease by biopsy. One patient is still alive with no evidence of disease after 5 years. The others died of recurrent neuroblastoma a median of 14 months (range 3-29) after transplant.

APBCT is safe and effective for hematopoietic reconstitution after high-dose chemotherapy, and may be useful when a bone marrow harvest cannot be performed because of prior pelvic radiation or minimal residual bone marrow metastasis. Immunocytological methods to ensure that the product is free of tumor contamination should be performed.