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Outcomes following autologous hematopoietic stem cell transplant for patients with relapsed Wilms’ tumor: a CIBMTR retrospective analysis

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Abstract

Despite the marked improvement in the overall survival (OS) for patients diagnosed with Wilms’ tumor (WT), the outcomes for those who experience relapse have remained disappointing. We describe the outcomes of 253 patients with relapsed WT who received high-dose chemotherapy (HDT) followed by autologous hematopoietic stem cell transplant (HCT) between 1990 and 2013, and were reported to the Center for International Blood and Marrow Transplantation Research. The 5-year estimates for event-free survival (EFS) and OS were 36% (95% confidence interval (CI); 29–43%) and 45% (95 CI; 38–51%), respectively. Relapse of primary disease was the cause of death in 81% of the population. EFS, OS, relapse and transplant-related mortality showed no significant differences when broken down by disease status at transplant, time from diagnosis to transplant, year of transplant or conditioning regimen. Our data suggest that HDT followed by autologous HCT for relapsed WT is well tolerated and outcomes are similar to those reported in the literature. As attempts to conduct a randomized trial comparing maintenance chemotherapy with consolidation versus HDT followed by stem cell transplant have failed, one should balance the potential benefits with the yet unknown long-term risks. As disease recurrence continues to be the most common cause of death, future research should focus on the development of consolidation therapies for those patients achieving complete response to therapy.

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Acknowledgements

CIBMTR Support List: The CIBMTR is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research; and grants from *Actinium Pharmaceuticals, Inc.; Alexion; *Amgen, Inc.; Anonymous donation to the Medical College of Wisconsin; Astellas Pharma USA; AstraZeneca; Atara Biotherapeutics, Inc.; Be the Match Foundation; *Bluebird Bio, Inc.; *Bristol Myers Squibb Oncology; *Celgene Corporation; Cellular Dynamics International, Inc.; Cerus Corporation; *Chimerix, Inc.; Fred Hutchinson Cancer Research Center; Gamida Cell Ltd.; Genentech, Inc.; Genzyme Corporation; Gilead Sciences, Inc.; Health Research, Inc. Roswell Park Cancer Institute; HistoGenetics, Inc.; Incyte Corporation; Janssen Scientific Affairs, LLC; *Jazz Pharmaceuticals, Inc.; Jeff Gordon Children’s Foundation; The Leukemia & Lymphoma Society; Medac, GmbH; MedImmune; The Medical College of Wisconsin; *Merck & Co, Inc.; *Mesoblast; MesoScale Diagnostics, Inc.; *Miltenyi Biotec, Inc.; National Marrow Donor Program; Neovii Biotech NA, Inc.; Novartis Pharmaceuticals Corporation; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc.; Otsuka America Pharmaceutical, Inc.; Otsuka Pharmaceutical Co, Ltd.—Japan; PCORI; Perkin Elmer, Inc.; Pfizer, Inc; *Sanofi USA; *Seattle Genetics; *Spectrum Pharmaceuticals, Inc.; St Baldrick’s Foundation; *Sunesis Pharmaceuticals, Inc.; Swedish Orphan Biovitrum, Inc.; Takeda Oncology; Telomere Diagnostics, Inc.; University of Minnesota; and *Wellpoint, Inc. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration (HRSA) or any other agency of the USA Government. *Corporate Members

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Authors and Affiliations

  1. Davis Cancer Center, University of California, Sacramento, CA, USA

    M H Malogolowkin

  2. Department of Medicine, CIBMTR (Center for International Blood and Marrow Research), Medical College of Wisconsin, Milwaukee, WI, USA

    M T Hemmer

  3. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    J Le-Rademacher

  4. Department of Hematology/Oncology, Johns Hopkins All Children’s Hospital, St Petersburg, FL, USA

    G A Hale

  5. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    P A Mehta

  6. Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

    A R Smith

  7. Vanderbilt University Medical Center, Nashville, TN, USA

    C Kitko

  8. Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children’s National Medical Center, Washington, DC, USA

    A Abraham

  9. Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    H Abdel-Azim

  10. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

    C Dandoy

  11. Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain

    M Angel Diaz

  12. Division of Experimental Medicine, Department of Medicine, Hematology Research Centre, Imperial College London, London, UK

    R P Gale

  13. Section of Paediatric Oncology and Blood and Marrow Transplant, Alberta Children’s Hospital, Calgary, AB, Canada

    G Guilcher

  14. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, MO, USA

    R Hayashi

  15. Cincinnatti Children’s Hospital, Cincinnati, OH, USA

    S Jodele

  16. Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    K A Kasow

  17. University of Minnesota Blood and Marrow Transplant Program, Minneapolis, MN, USA

    M L MacMillian

  18. Medical College of Wisconsin, Milwaukee, WI, USA

    M Thakar & E L Thiel

  19. Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA

    B M Wirk

  20. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    A Woolfrey

Authors
  1. M H Malogolowkin
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  2. M T Hemmer
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  3. J Le-Rademacher
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  4. G A Hale
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  5. P A Mehta
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  6. A R Smith
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  7. C Kitko
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  8. A Abraham
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  9. H Abdel-Azim
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  10. C Dandoy
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  11. M Angel Diaz
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  12. R P Gale
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  13. G Guilcher
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  14. R Hayashi
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  15. S Jodele
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  16. K A Kasow
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  17. M L MacMillian
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  18. M Thakar
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  19. B M Wirk
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  20. A Woolfrey
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  21. E L Thiel
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Correspondence to E L Thiel.

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Malogolowkin, M., Hemmer, M., Le-Rademacher, J. et al. Outcomes following autologous hematopoietic stem cell transplant for patients with relapsed Wilms’ tumor: a CIBMTR retrospective analysis. Bone Marrow Transplant 52, 1549–1555 (2017). https://doi.org/10.1038/bmt.2017.178

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  • DOI: https://doi.org/10.1038/bmt.2017.178

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