Abstract
This survey includes 25 children with Wilms' tumor undergoing highโdose chemotherapy associated with autologous bone marrow transplantation (ABMT) in the period June 1984โDecember 1991 and enrolled in the European Bone Marrow Transplantation Registry for Solid Tumors. At diagnosis, 12 children presented stage IV disease, 5 stage III, 3 stage II, and 5 stage I. Before ABMT, 21 children had 1 to 4 relapses (median 1); 13 achieved a second or subsequent complete remission (CR), four stage IV children failed to respond to first line treatment and achieved either CR (3 patients), or partial remission (PR) after second line therapy. At highโdose chemotherapy, 17 children were in CR and 8 had measurable disease. Seven different highโdose regimens were administered, even if 20 children received melphalan mostly associated with vincristine and 8 involved field radiotherapy. Three children died early of pneumonitis; 2 developed an acute transient renal failure, 1 a chronic renal failure. Out of the 8 children with target disease at graft, 2 died of toxicity, 5 achieved CR, 1 obtained PR, and only 1 is presently alive in CCR at 39 months after ABMT. Of the 17 children grafted in CR, 8 are alive eventโfree at 14โ90 months (median 34) from ABMT; 7 relapsed at 3โ23 months (median 7 months); 1 died of toxicity and 1 was lost to followโup in CR at 12 months. A salvage attempt with highโdose chemotherapy in children with resistant or poor prognosis recurrent Wilms' tumor seems to be justified. An international cooperative protocol taking into account the increased risk of lung and renal toxicity is necessary. ยฉ 1994 WileyโLiss, Inc.