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Vol. 61. Núm. 1.
Páginas 8-15 (julio 2004)
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Vol. 61. Núm. 1.
Páginas 8-15 (julio 2004)
Acceso a texto completo
Trasplante autólogo con progenitores hematopoyéticos de sangre periférica en niños con tumores del sistema nervioso central de alto riesgo
High-dose chemotherapy with autologous stem cell rescue in children with high-risk and recurrent brain tumors
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A. Pérez Martínez, V. Quintero Calcaño, M. González Vicent, T. Contra Gómez, M.A. Díaz Pérez, L. Madero López
Autor para correspondencia
antonioperezmartinez@yahoo.es

Correspondencia: Unidad de Hemato-Oncología Pediátrica y Trasplante Hematopoyético. Hospital Infantil Universitario Niño Jesús. Avda. Menéndez Pelayo, 65. 28009 Madrid. España
, J. Sevilla Navarro
Hospital Infantil Universitario Niño Jesús. Madrid. España
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Estadísticas
Antecedentes

En los últimos años ha mejorado discretamente la supervivencia de los niños con tumores del sistema nervioso central (SNC). Especialmente en tumores como el meduloblastoma y en aquellos en los que se consigue una resección quirúrgica completa. En cambio, los pacientes con resecciones quirúrgicas incompletas, tumores diseminados por el neuroeje, metastásicos, recurrentes o en los pacientes de menor edad, el pronóstico resulta muy pobre

Objetivos

Con intención de mejorar el pronóstico de los pacientes de alto riesgo y con enfermedad recurrente, se han desarrollado nuevas estrategias terapéuticas como el trasplante autólogo de progenitores hematopoyéticos (TAPH)

Métodos

Revisión retrospectiva de los pacientes con tumores de alto riesgo del SNC y recurrentes sometidos a TAPH entre los meses de septiembre de 1995 y diciembre de 2002 en nuestra unidad

Resultados

Un total de 35 pacientes fueron trasplantados. Fallecieron 7 pacientes (20%) por toxicidad del procedimiento y 15 pacientes (42%) por enfermedad progresiva, 13 pacientes se encuentran vivos, con una mediana de seguimiento tras el trasplante de 18 meses (5–63 meses). La supervivencia libre de enfermedad (SLE) estimada mediante el método de Kaplan-Meier con una mediana de 2 años fue de 37,64 ± 8,7%, en todos los pacientes; de 57 ± 15% en los pacientes con meduloblastoma/tumor primitivo neuroectodérmico supratentorial (MB/stPNET) de alto riesgo, y de 71,43 ± 17% en los pacientes con MB/stPNET menores de 4 años

Conclusiones

En nuestra experiencia el TAPH podría ser efectivo en el tratamiento de los tumores malignos del SNC en pacientes con enfermedad controlada y en determinados grupos histológicos, tumores quimiosensibles (meduloblastoma, astrocitoma anaplásico), así como en los niños de menor edad donde la radioterapia craneal está contraindicada

Palabras clave:
Trasplante autólogo de progenitores hematopoyéticos
Tumores de alto riesgo de SNC
Meduloblastoma
stPNET
Astrocitoma anaplásico
Background

In the last few years, survival in children with central nervous system (CNS) tumors has slightly improved, especially in children with tumors such as medulloblastoma and those in which complete surgical resection is achieved

However, outcome remains poor in patients with incomplete surgical resection, neuroaxial dissemination, metastatic or recurrent tumors and in very young children

Objectives

To improve prognosis in patients with high-risk and recurrent tumors, new therapeutic strategies such as high-dose chemotherapy with autologous stem cell rescue (ASCR) have been developed

Methods

We retrospectively studied patients with high-risk and recurrent CNS tumors who underwent ASCR between September 1995 and December 2002 in our unit

Results

Thirty-five patients underwent ASCR. Seven patients died of treatment-related toxicities (20%). Thirteen (37%) are event-free survivors at a median post-ASCR follow-up of 18 months (range: 5–63 months). The 2-year Kaplan-Meier estimates of event-free survival was 37.64 ± 8.7% in all patients, 57 ± 15% in the group of patients with high-risk medulloblastoma/supratentorial primitive neuroectodermal tumor (stPNET) and 71.43 ± 17% in patients aged less than 4 years with medulloblastoma/stPNET

Conclusions

In our experience, ASCR may be effective in the treatment of malignant tumors of the central nervous system in patients with controlled disease, in certain histologic groups and chemosensitive tumors (medulloblastoma, malignant astrocytoma), as well as in very young children in whom cranial radiotherapy is contraindicated

Keywords:
Autologous stem cell rescue
High-risk brain tumors
Medulloblastoma
stPNET
Malignant astrocytoma
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Copyright © 2004. Asociación Española de Pediatría
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