Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma

Ahmed Elhemaly; Ahmed Fathalla; Mahmed Elhusseny; Mohamed Fawzy

doi:doi:10.11648/j.crj.20210902.11

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Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma

Ahmed Elhemaly, Ahmed Fathalla, Mahmed Elhusseny, Mohamed Fawzy

Published in Cancer Research Journal (Volume 9, Issue 2)

Received: 13 March 2021 Accepted: 27 March 2021 Published: 7 April 2021

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Abstract

Background: High-risk Neuroblastoma (N. B) patients have a poor outcome with 5-year survival rates of 50%. Patients with stage 4 disease or MYC-N amplification showed post-progression 5y O. S. of 7% to 8%. Other studies proved the same dismal outcome in high-risk relapsed patients. This study aimed to detect the O. S. and EFS of N. B patients post-progression. Secondary to explore, if initial prognostic factors, high-intensity salvage therapy and other treatment modalities could improve the outcome of progressive /refractory disease. Methods: Seventy patients of high-risk Neuroblastoma needed salvage therapy, either due to refractory/progressive disease or irresectability of the primary tumor. Initial prognostic factors and different treatment strategies were collected and correlated with the outcome. Results: Fifty-seven (57 /70) patients died from progressive disease with a median survival of 20.6 months with three y EFS and O. S. of 9.5% and 35.7%, respectively. Objective response (CR/VGPR/PR) post-induction, consolidation by HSCT, radiotherapy, and maintenance therapy; affected survival significantly post salvage therapy. Multivariate analysis revealed that the only independent factor that significantly affected O. S was maintenance therapy. The independent factors that affected the EFS negatively were the presence of liver metastases, poor response post-induction, and not administering radiotherapy. Conclusion: Response to induction had a significant impact on the outcome post salvage. Salvage therapy did not improve the outcome for those with inadequate induction response. Initial front-line targeted therapy like antiGD2 is needed to improve the outcome, especially for chemo-resistant ones.

Published in	Cancer Research Journal (Volume 9, Issue 2)
DOI	10.11648/j.crj.20210902.11
Page(s)	85-91
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Salvage, Neuroblastoma, High Risk-Low Middle, Income Countries

References

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APA Style

Ahmed Elhemaly, Ahmed Fathalla, Mahmed Elhusseny, Mohamed Fawzy. (2021). Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma. Cancer Research Journal, 9(2), 85-91. https://doi.org/10.11648/j.crj.20210902.11

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ACS Style

Ahmed Elhemaly; Ahmed Fathalla; Mahmed Elhusseny; Mohamed Fawzy. Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma. Cancer Res. J. 2021, 9(2), 85-91. doi: 10.11648/j.crj.20210902.11

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AMA Style

Ahmed Elhemaly, Ahmed Fathalla, Mahmed Elhusseny, Mohamed Fawzy. Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma. Cancer Res J. 2021;9(2):85-91. doi: 10.11648/j.crj.20210902.11

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@article{10.11648/j.crj.20210902.11,
  author = {Ahmed Elhemaly and Ahmed Fathalla and Mahmed Elhusseny and Mohamed Fawzy},
  title = {Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma},
  journal = {Cancer Research Journal},
  volume = {9},
  number = {2},
  pages = {85-91},
  doi = {10.11648/j.crj.20210902.11},
  url = {https://doi.org/10.11648/j.crj.20210902.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20210902.11},
  abstract = {Background: High-risk Neuroblastoma (N. B) patients have a poor outcome with 5-year survival rates of 50%. Patients with stage 4 disease or MYC-N amplification showed post-progression 5y O. S. of 7% to 8%. Other studies proved the same dismal outcome in high-risk relapsed patients. This study aimed to detect the O. S. and EFS of N. B patients post-progression. Secondary to explore, if initial prognostic factors, high-intensity salvage therapy and other treatment modalities could improve the outcome of progressive /refractory disease. Methods: Seventy patients of high-risk Neuroblastoma needed salvage therapy, either due to refractory/progressive disease or irresectability of the primary tumor. Initial prognostic factors and different treatment strategies were collected and correlated with the outcome. Results: Fifty-seven (57 /70) patients died from progressive disease with a median survival of 20.6 months with three y EFS and O. S. of 9.5% and 35.7%, respectively. Objective response (CR/VGPR/PR) post-induction, consolidation by HSCT, radiotherapy, and maintenance therapy; affected survival significantly post salvage therapy. Multivariate analysis revealed that the only independent factor that significantly affected O. S was maintenance therapy. The independent factors that affected the EFS negatively were the presence of liver metastases, poor response post-induction, and not administering radiotherapy. Conclusion: Response to induction had a significant impact on the outcome post salvage. Salvage therapy did not improve the outcome for those with inadequate induction response. Initial front-line targeted therapy like antiGD2 is needed to improve the outcome, especially for chemo-resistant ones.},
 year = {2021}
}

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TY - JOUR
T1 - Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma
AU - Ahmed Elhemaly
AU - Ahmed Fathalla
AU - Mahmed Elhusseny
AU - Mohamed Fawzy
Y1 - 2021/04/07
PY - 2021
N1 - https://doi.org/10.11648/j.crj.20210902.11
DO - 10.11648/j.crj.20210902.11
T2 - Cancer Research Journal
JF - Cancer Research Journal
JO - Cancer Research Journal
SP - 85
EP - 91
PB - Science Publishing Group
SN - 2330-8214
UR - https://doi.org/10.11648/j.crj.20210902.11
AB - Background: High-risk Neuroblastoma (N. B) patients have a poor outcome with 5-year survival rates of 50%. Patients with stage 4 disease or MYC-N amplification showed post-progression 5y O. S. of 7% to 8%. Other studies proved the same dismal outcome in high-risk relapsed patients. This study aimed to detect the O. S. and EFS of N. B patients post-progression. Secondary to explore, if initial prognostic factors, high-intensity salvage therapy and other treatment modalities could improve the outcome of progressive /refractory disease. Methods: Seventy patients of high-risk Neuroblastoma needed salvage therapy, either due to refractory/progressive disease or irresectability of the primary tumor. Initial prognostic factors and different treatment strategies were collected and correlated with the outcome. Results: Fifty-seven (57 /70) patients died from progressive disease with a median survival of 20.6 months with three y EFS and O. S. of 9.5% and 35.7%, respectively. Objective response (CR/VGPR/PR) post-induction, consolidation by HSCT, radiotherapy, and maintenance therapy; affected survival significantly post salvage therapy. Multivariate analysis revealed that the only independent factor that significantly affected O. S was maintenance therapy. The independent factors that affected the EFS negatively were the presence of liver metastases, poor response post-induction, and not administering radiotherapy. Conclusion: Response to induction had a significant impact on the outcome post salvage. Salvage therapy did not improve the outcome for those with inadequate induction response. Initial front-line targeted therapy like antiGD2 is needed to improve the outcome, especially for chemo-resistant ones.
VL - 9
IS - 2
ER -

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Author Information

Ahmed Elhemaly

Pediatric Oncology, National Cancer Institute (NCI)-Cairo University and Children Cancer Hospital of Egypt (CCHE), Cairo, Egypt
Ahmed Fathalla

Surgical Oncology, National Cancer Institute, Cairo, Egypt
Mahmed Elhusseny

Pediatric Oncology, Children cancer Hospital of Egypt, Cairo, Egypt
Mohamed Fawzy

Pediatric Oncology, National Cancer Institute (NCI)-Cairo University and Children Cancer Hospital of Egypt (CCHE), Cairo, Egypt

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APA Style

Ahmed Elhemaly, Ahmed Fathalla, Mahmed Elhusseny, Mohamed Fawzy. (2021). Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma. Cancer Research Journal, 9(2), 85-91. https://doi.org/10.11648/j.crj.20210902.11

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ACS Style

Ahmed Elhemaly; Ahmed Fathalla; Mahmed Elhusseny; Mohamed Fawzy. Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma. Cancer Res. J. 2021, 9(2), 85-91. doi: 10.11648/j.crj.20210902.11

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AMA Style

Ahmed Elhemaly, Ahmed Fathalla, Mahmed Elhusseny, Mohamed Fawzy. Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma. Cancer Res J. 2021;9(2):85-91. doi: 10.11648/j.crj.20210902.11

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@article{10.11648/j.crj.20210902.11,
  author = {Ahmed Elhemaly and Ahmed Fathalla and Mahmed Elhusseny and Mohamed Fawzy},
  title = {Impact of Initial Prognostic Factors and Intensity of Salvage Therapy on the Outcome of Progressive / Refractory High-Risk Neuroblastoma},
  journal = {Cancer Research Journal},
  volume = {9},
  number = {2},
  pages = {85-91},
  doi = {10.11648/j.crj.20210902.11},
  url = {https://doi.org/10.11648/j.crj.20210902.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20210902.11},
  abstract = {Background: High-risk Neuroblastoma (N. B) patients have a poor outcome with 5-year survival rates of 50%. Patients with stage 4 disease or MYC-N amplification showed post-progression 5y O. S. of 7% to 8%. Other studies proved the same dismal outcome in high-risk relapsed patients. This study aimed to detect the O. S. and EFS of N. B patients post-progression. Secondary to explore, if initial prognostic factors, high-intensity salvage therapy and other treatment modalities could improve the outcome of progressive /refractory disease. Methods: Seventy patients of high-risk Neuroblastoma needed salvage therapy, either due to refractory/progressive disease or irresectability of the primary tumor. Initial prognostic factors and different treatment strategies were collected and correlated with the outcome. Results: Fifty-seven (57 /70) patients died from progressive disease with a median survival of 20.6 months with three y EFS and O. S. of 9.5% and 35.7%, respectively. Objective response (CR/VGPR/PR) post-induction, consolidation by HSCT, radiotherapy, and maintenance therapy; affected survival significantly post salvage therapy. Multivariate analysis revealed that the only independent factor that significantly affected O. S was maintenance therapy. The independent factors that affected the EFS negatively were the presence of liver metastases, poor response post-induction, and not administering radiotherapy. Conclusion: Response to induction had a significant impact on the outcome post salvage. Salvage therapy did not improve the outcome for those with inadequate induction response. Initial front-line targeted therapy like antiGD2 is needed to improve the outcome, especially for chemo-resistant ones.},
 year = {2021}
}

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