Autologous cord blood transplantation for metastatic neuroblastoma

Auto-SCT is a common approach for metastatic neuroblastoma with the intention to rescue hematopoiesis after megadose chemotherapy. PBSC or BM is the usual stem cell source for auto-SCT. Auto-CBT for neuroblastoma has very rarely been performed. Currently, case reports are available for two patients only. We performed 13 auto-SCTs for high-risk neuroblastoma from 2007 to 2013, including four cases of metastatic neuroblastoma aged 11–64 months treated with auto-CBT. All four patients had partial or CR to upfront treatments before auto-CBT. Nucleated cell dose and CD34+ cell dose infused were 2.8–8.7 × 10⁷/kg and 0.36–3.9 × 10⁵/kg, respectively. Post-thawed viability was 57–76%. Neutrophil engraftment (>0.5 × 10⁹/L) occurred at 15–33 days, while platelet engraftment occurred at 31–43 days (>20 × 10⁹/L) and 33–65 days (>50 × 10⁹/L) post-transplant, respectively. There was no severe acute or chronic complication. Three patients survived for 1.9–7.7 yr without evidence of recurrence. One patient relapsed at 16 months post-transplant and died of progressive disease. Cord blood may be a feasible alternative stem cell source for auto-SCT in patients with stage 4 neuroblastoma, and outcomes may be improved compared to autologous PBSC or BM transplants.