Effects of Purging Tumor Cells From Stem Cells in Patients Transplanted for High-Risk Neuroblastoma
Randomized, phase 3, multicenter clinical trial compares outcomes
Media Contact: Ellin Kavanagh
LOS ANGELES (July 25, 2013) Judith Villablanca, MD, of The Saban Research Institute of Children’s Hospital Los Angeles, Susan Kreissman, MD, of Duke University Medical Center, and colleagues reported the results of a randomized, phase 3 clinical trial conducted by the Children’s Oncology Group examining the effect of selectively removing (purging) tumor cells from blood stem cells before they are transplanted back into patients with high-risk neuroblastoma following high-dose chemotherapy. This is the first randomized trial looking at the effect of tumor selective stem cell purging on patient outcome. The study will be published online July 25 in the prestigious journal Lancet Oncology.
Neuroblastoma is the second most common solid tumor in children. Half of all children diagnosed with this condition have high-risk disease, meaning that they are less responsive to treatment and have less than a 50% chance of survival.
Standard treatment includes a course of high dose chemotherapy because it is more effective at killing tumor cells, however, it also kills the normal blood-forming cells in the bone marrow. In order to mitigate this effect, some immature blood cells (called peripheral blood stem cells or PBSC) are removed before the child is treated with high dose chemotherapy and then re-infused after treatment. This procedure is called an autologous peripheral blood stem cell transplant.
Since neuroblastoma often spreads into the blood and bone marrow, stem cells collected for transplant may be mixed with tumor cells. It was not known if removing tumor cells from the stem cells would change the outcome for patients. To find out, Robert Seeger, MD, Patrick Reynolds, MD, PhD and their team at Children’s Hospital Los Angeles, developed a technique for removing or “purging” the tumor cells from the blood stem cells. This technique involved using antibodies that attached the tumor cells to magnetic beads, and then were removed using strong magnets. Purging stem cells as well as the high dose chemotherapy regimen used in this study were both first piloted in a prior multi-center trial led by Children’s Hospital Los Angeles and chaired by Dr. Villablanca.
This multicenter, phase 3 clinical trial randomized patients to receive either purged or non-purged PBSC following high dose chemotherapy. Purging was done, for all patients randomized to that treatment, at a centralized lab at Children’s Hospital Los Angeles. The study showed that purging stem cells prior to transplant did not significantly affect patient survival, suggesting that patients had other tumor sites in their body that were not effectively treated by the high dose chemotherapy. This information now allows oncologists to eliminate the complex and expensive purging process. Future investigations will focus on new therapies that are more effective at killing resistant tumor cells throughout the body.
A second important finding from this study was that patient survival was not decreased when total body irradiation (TBI) was eliminated from the treatment regimen. TBI had been used in the previous COG transplant study. Eliminating TBI resulted in the reduction of serious radiation side effects including cataracts, short stature and abnormal tooth development.
“This study illustrates the importance of clinical trials developed as a partnership between lab scientists and clinical researchers to create optimal therapies for treating children with cancer. Each successive trial builds on the previous one allowing us to continuously be working on safer and more effective treatments,” says Judith Villablanca, MD, principal investigator at Children’s Hospital and Professor of Clinical Pediatrics at the Keck School of Medicine of the University of Southern California.
The extremely sensitive tumor cell detection method called “TLDA” was developed by Robert C. Seeger, MD, Director of the Cancer Research Program at The Saban Research Institute. Tumor cells detected by TLDA in the PBSC prior to purging predicted which patients would have worse outcomes. Testing for tumor using this method may provide a new marker to help identify which patients are less likely to respond to standard therapy and who might benefit from more novel approaches.
“Our new TLDA test, which can be used to test bone marrow, blood, or PBSC during the course of therapy or at the end of all therapy provides an excellent means of assessing the response of the patient’s tumor cells to treatment. This response assessment appears to be very helpful in predicting patient outcome,” says Robert C. Seeger, MD, who is also Professor of Pediatrics at the Keck School of Medicine of USC.
Children’s Hospital Los Angeles is also the lead institution in the “New Approaches to Neuroblastoma Therapy” (www.nant.org) clinical trials consortium, which includes 15 neuroblastoma centers in the US and Canada, and is focused on developing these novel therapies for children with neuroblastoma who are currently failing standard treatment approaches.
Co-authors on this study include Robert Seeger, MD (Children’s Hospital Los Angeles), Patrick Reynolds MD, PhD (Texas Tech University Health Sciences Center), Katherine Matthay, MD (University of California, San Francisco), Wendy London, PhD (Dana-Farber Cancer Institute), Richard Sposto, PhD (Children’s Hospital Los Angeles), Stephen Grupp MD (Children’s Hospital Philadelphia), Daphne Haas-Kogan MD (University of California, San Francisco), Michael LaQuaglia, MD (Memorial Sloan Kettering Cancer Center), Alice Yu, MD (Rady Children’s Hospital), Lisa Diller MD (Dana-Farber Harvard Cancer Institute), Allen Buxton, MS (Children’s Oncology Group), Julie Park, MD (Seattle Children’s Hospital), Susan Cohn, MD (University of Chicago), and John Maris, MD (Children’s Hospital Philadelphia).
Link to the study: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(13)70309-7/fulltext
About Children’s Oncology Group
The Children’s Oncology Group (www.childrensoncologygroup.org) is the world’s largest organization devoted exclusively to childhood and adolescent cancer research. The Children’s Oncology Group (COG) unites more than 8,000 experts in childhood cancer at more than 200 leading children’s hospitals, universities, and cancer centers across North America, Australia, New Zealand, and parts of Europe in the fight against childhood cancer. Today, more than 90% of the13,500 children and adolescents diagnosed with cancer each year in the United States are cared for at COG member institutions. Research performed by the Children’s Oncology Group institutions over the past fifty years has transformed childhood cancer from a virtually incurable disease to one with a combined 5-year survival rate of 80%. COG’s mission is to improve the cure rate and outcome for all children with cancer.
About Children's Hospital Los Angeles
Children's Hospital Los Angeles has been named the best children’s hospital on the West Coast and among the top five in the nation for clinical excellence with its selection to the prestigious U.S. News & World Report Honor Roll. Children’s Hospital is home to The Saban Research Institute, one of the largest and most productive pediatric research facilities in the United States. Children’s Hospital is also one of America's premier teaching hospitals through its affiliation since 1932 with the Keck School of Medicine of the University of Southern California.
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