Proposed strategy for the use of high-dose chemotherapy with stem cell rescue and intrathecal topotecan without whole-brain irradiation for infantile classic medulloblastoma

Pediatr Blood Cancer. 2014 Dec;61(12):2316-8. doi: 10.1002/pbc.25174. Epub 2014 Aug 30.

Abstract

We describe a 6-month-old infant with classic medulloblastoma. Gross total resection of the left cerebellar tumor was performed; however, relapse occurred during the administration of intrathecal and intravenous methotrexate-based chemotherapy. After undergoing resection, high-dose chemotherapy was administered consisting of topotecan, melphalan, and cyclophosphamide with autologous peripheral stem cell rescue followed by local irradiation and intrathecal topotecan, which resulted in a complete response for more than two years. The administration of high-dose chemotherapy followed by intrathecal topotecan as maintenance therapy is an effective strategy, without losses in the cognitive function, for avoiding the use of whole-brain irradiation for infantile classic medulloblastoma.

Keywords: high-dose chemotherapy; histology; infantile medulloblastoma; intrathecal topotecan; stem cell transplantation.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cerebellar Neoplasms / pathology
  • Cerebellar Neoplasms / therapy*
  • Combined Modality Therapy
  • Cranial Irradiation*
  • Cyclophosphamide / administration & dosage
  • Female
  • Humans
  • Infant
  • Injections, Spinal
  • Medulloblastoma / pathology
  • Medulloblastoma / therapy*
  • Melphalan / administration & dosage
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / therapy*
  • Prognosis
  • Stem Cell Transplantation*
  • Topotecan / administration & dosage
  • Transplantation, Autologous

Substances

  • Topotecan
  • Cyclophosphamide
  • Melphalan