Big decisions need to be made this week – pursue a stem cell transplant at CHOP or skip it and pursue treatment at MSKCC.
CHOP – Cheesesteaks in Phili?
Today we setout to learn more about the CHOP option. We packed up the car early at 7am (not early by Jackson’s new 5:30 wake up time) and headed down to Phili to meet with Steve Grupp to discuss plans for Jackson’s stem cell transplant. Steve was very helpful and answered all of our questions. We became more comfortable with the long term risks of stem cell transplant, however are still questioning whether the risks and toxicity of the process are worth the potential benefits.
Essentially a stem cell transplant is a means of delivering a high dose of chemotherapy to your body. The doseage they give is so intense it destroys your bone marrow and you need to have your own stem cell transplanted back into you to restart the growth process. It is a sledge hammer approach to eliminate any remaining minimal residual disease with the goal of eliminated relapes. The upside is that it should in theory kill off any remaining neuroblastoma cells and it could potentially reduce secondary cancer risk as you rejuvinate your bone marrow with cells that haven’t been through as many toxic rounds of chemo (2-3% risk of developing leukemia from chemotherapy). The COG points to the results of their CCG3891 study published in 1999 that shows a survival benefit from stem cell transplant vs. no stem cell transplant.
The downside is that 3% of patients die from complications during the transplant and nearly 100% are sterile after the process.
MSKCC – Pizza in NYC?
Memorial Sloan-Kettering takes a different approach from the rest of the world in that they don’t believe stem cell transplants are beneficial for neuroblastoma patients. Sloan has been using their antibody 3F8 to treat minimal residual disease for many years (only available at MSKCC). Sloan carried out stem cell transplants on neuroblastoma patients from 1980-1989 but after evaluating their own internal data, they determined the stem cell transplant didn’t add any additional benefit when given along with 3F8. As a result, they eliminated it from their treatment protocol in 1989 and achieved good results. After the COG published results of their CCG3891 study in 1999 which showed a clear advantage for stem cell transplants vs. no stem cell transplants, Sloan brought back stem cell transplants to make sure they didn’t miss anything. After reviewing their internal data and again seeing no difference in survival rates, they again eliminated stem cell transplants from their treatment protocol in 2003.
The biggest risk to MSKCC is developing early HAMA and not being able to receive enough 3F8 to be effective (4 or more rounds found to be most effective). HAMA or “human anti-mouse antibodies” are a result of the body developing antibodies to fight off 3F8, which is developed from the white blood cells of mice. By using a variety of drugs, MSKCC believes it is a less than 10% risk of developing HAMA if 3F8 is started within 90 days of chemotherapy.
Decisions, decisions, decisions…this is not an easy decision!