Cancer Treatment Today

In a recent manuscript, Ha et al, reviewed the data from 19 relevant publications in an attempt to determine the role of HDT followed by HCT in the treatment of relapsed WT. The authors used pooled data of 1226 patients to compare the overall 3-year EFS and OS between patients treated with HDT followed by HCT with dose treated without HDT (conventional chemotherapy).21 The median 3-year EFS and OS for patients who did not received HDT was 47.6% (1.76–79.83%) and 47.5% (3.7–100%), respectively, compared to 47% (3.7–100%) and 47.5% (12.5–100%) for those treated with HDT followed by HCT.21 The authors concluded that the evidence suggest the value of HDT followed by HCT, particularly for those in the highest risk relapse group based on initial stage, histology, initial treatment received and prior relapse.

A recent international meta-analysis conducted by Presson et al, to provide additional insights in the role of HDT followed by HCT revealed that the patients most likely to benefit from this approach were those initially treated with four or more chemotherapeutic agents and those with multiple relapses or progression on salvage therapy.

Thus, there may be some advantage to an autologous stem cell transplant, less known about allogeneic and , if there is an advantage, it is not great. There is an ongoing phase II ciniccal trial: Chemotherapy Followed by Surgery and Radiation Therapy With or Without Stem Cell Transplant in Treating Patients With Relapsed or Refractory Wilms’ Tumor or Clear Cell Sarcoma of the Kidney, NCT00025103

A retrospective analysis by Ha Et al support this approach’ however, a subsequent review says this: “A recent review by T.C. Ha and colleagues of the published cases to date suggests HDT may be beneficial to the very high risk subset of patients with recurrent WT, but this conclusion is fraught with the caveats of any retrospective review. ”

Ha TC, Spreafico F, Graf N, et al. An international strategy to determine the role of high dose therapy in recurrent Wilms’ tumour. Eur J Cancer 2013;49:194-210.

High dose therapy for recurrent Wilms’ tumor. Transl Pediatr. 2014;3(1):25-8.

Presson A, Moore TB, Kempert P. Efficacy of High-dose Chemotherapy and Autologous Stem Cell transplant for Recurrent Wilms’ Tumor: A Meta-Analysis. J Ped Hematology/Oncology. 2010;32(6):454–461

Ha TC, Spreafico F, Graf N, Dallorso S, Dome JS, Malogolowkin M, et al. An international strategy to determine the role of high dose therapy in recurrent Wilms’ tumour. Eur J Cancer. 2013;49:194–210.

Malogolowkin MH, Hemmer MT, 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. 2017;52(11):1549-1555.
Nirali N.Shah et al, Induction of Immune Response after Allogeneic Wilms’ Tumor 1 Dendritic Cell Vaccination and Donor Lymphocyte Infusion in Patients with Hematologic Malignancies and Post-Transplantation Relapse Biology of Blood and Marrow Transplantation Volume 22, Issue 12, December 2016, Pages 2149-