TY - JOUR
T1 - High-dose ifosfamide in relapsed pediatric osteosarcoma
T2 - Therapeutic effects and renal toxicity
AU - Berrak, Su Gülsün
AU - Pearson, Margaret
AU - Berberoǧlu, Semha
AU - Ilhan, Inci Ergürhan
AU - Jaffe, Norman
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2005/3
Y1 - 2005/3
N2 - Background. Sixteen pediatric osteosarcoma patients, previously treated with conventional chemotherapy (including ifosfamide (IFX), 9 g/m2) were retreated with high-dose ifosfamide (HD-IFX, 14 g/m2 per course), following relapse or development of a new bone tumor. The objective was to obtain responses and an improved event-free survival (EFS). Procedure. HD-IFX was administered as described by Patel SR: J Clin Oncol 1997;15:2378. Efficacy of treatment was assessed initially after two to four courses. The interval between the courses was 3 to 4 weeks. Provided a response was obtained after two to four courses, treatment was continued for an additional eight courses unless progressive disease or an untoward event, for example, renal failure occurred. Tumor sites were: lung, (10) bone (9), and bone and soft-tissue (1). Results. Response after two to four courses was 62.5%: CR 6 and PR 4. A total of 84 courses were administered to the 16 patients: (range 2-10, median 5.5 per patient). Median interval between courses was 28.5 days (range 15-90). Five patients were disease free at 15+ to 63+ months after induction and maintenance therapy. Fever and neutropenia occurred in 12 courses. Nephrotoxicity was a major toxic event and was characterized by creatinine levels at or above three times the upper limit of normal. It was unpredictable and occurred in four patients: two were reversible. The other two patients developed full-blown renal failure; one was treated with renal dialysis, but both eventually succumbed to osteosarcoma. Our past experience also indicated that two patients treated with IFX (9 g/m2/course) developed renal failure: one recovered and the other required a renal transplant: Conclusions. HD-IFX is effective in patients who have failed conventional chemotherapy including IFX (9 g/m2). Improved disease-free survival was achieved in 30% of patients. However, renal failure constitutes an important life-threatening complication and its development is unpredictable.
AB - Background. Sixteen pediatric osteosarcoma patients, previously treated with conventional chemotherapy (including ifosfamide (IFX), 9 g/m2) were retreated with high-dose ifosfamide (HD-IFX, 14 g/m2 per course), following relapse or development of a new bone tumor. The objective was to obtain responses and an improved event-free survival (EFS). Procedure. HD-IFX was administered as described by Patel SR: J Clin Oncol 1997;15:2378. Efficacy of treatment was assessed initially after two to four courses. The interval between the courses was 3 to 4 weeks. Provided a response was obtained after two to four courses, treatment was continued for an additional eight courses unless progressive disease or an untoward event, for example, renal failure occurred. Tumor sites were: lung, (10) bone (9), and bone and soft-tissue (1). Results. Response after two to four courses was 62.5%: CR 6 and PR 4. A total of 84 courses were administered to the 16 patients: (range 2-10, median 5.5 per patient). Median interval between courses was 28.5 days (range 15-90). Five patients were disease free at 15+ to 63+ months after induction and maintenance therapy. Fever and neutropenia occurred in 12 courses. Nephrotoxicity was a major toxic event and was characterized by creatinine levels at or above three times the upper limit of normal. It was unpredictable and occurred in four patients: two were reversible. The other two patients developed full-blown renal failure; one was treated with renal dialysis, but both eventually succumbed to osteosarcoma. Our past experience also indicated that two patients treated with IFX (9 g/m2/course) developed renal failure: one recovered and the other required a renal transplant: Conclusions. HD-IFX is effective in patients who have failed conventional chemotherapy including IFX (9 g/m2). Improved disease-free survival was achieved in 30% of patients. However, renal failure constitutes an important life-threatening complication and its development is unpredictable.
KW - High-dose ifosfamide
KW - Metastatic
KW - Osteosarcoma
KW - Relapsed
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U2 - 10.1002/pbc.20228
DO - 10.1002/pbc.20228
M3 - Article
C2 - 15503294
AN - SCOPUS:13444253743
SN - 1545-5009
VL - 44
SP - 215
EP - 219
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
IS - 3
ER -