Comment on: Consolidation treatment for high risk solid tumors in children with myeloablative chemotherapy and autologous hematopoietic progenitor stem cell transplantation (original) (raw)

Abstract

This paper reports on a small number of patients with a diverse group of diagnoses that were consolidated with high-dose therapy and rescued with autologous hematopoietic progenitor cells (HPC) . One of the problems with this manuscript and many others is that the studies that have been performed and reported in the literature only reflect those patients who get the rescue and the survival advantage is from that point on. Second the number of patients is small and conclusions about the effectiveness of the procedure are not reliable. The only exception to these two problems has been the report of the only randomized trial for patients with high-risk neuroblastoma that actually includes all patients from diagnosis and shows a slight benefit of autologous hematopoietic stem cell rescue vs. conventional therapy . Does that mean that autologous hematopoietic stem cell rescue is not an effective therapy. My response is that maybe an effective consolidation therapy in a selected group of patients with certain diagnoses. For example, in patients with recurrent Wilms tumors who achieve a second complete remission and are consolidated with high-dose therapy and autologous HPC do very well unfortunately the reports about the benefit are with multiple different conditioning regimens some with a single rescue and others with a double rescue where deciding what is the standard to which we can compare results is not available. Other reports have shown that the survival in the same group of patients maybe equally as good without HPC rescue .

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References (12)

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