ABSTRACT
BACKGROUND: Despite aggressive treatment for high-risk neuroblastoma (NB), event-free survival (EFS) remains <40%. In single arm studies, intensifying therapy with high-dose chemotherapy and tandem autologous stem cell rescue (HDC/SCR) improved outcome. We retrospectively describe our institutional experience in using HDC/SCR for patients with high-risk NB, focusing on outcome and acute toxicities. METHODS: Eighty-four patients with high-risk NB at Children's Healthcare of Atlanta treated over a 12-year time period underwent HDC/SCR as part of upfront therapy; 28 patients received a single HDC/SCR and 56 patients received tandem HDC/SCR. The two groups were compared in terms of EFS, overall survival (OS), and acute transplant related toxicities. RESULTS: Patients who received tandem HDC/SCR had a significantly improved EFS compared with patients who received a single HDC/SCR (4-year EFS 59.3 ± 6.7% vs. 26.8 ± 9.2%, P=0.01). Similarly, the 4-year OS was improved in patients receiving tandem HDC/SCR, though this did not reach statistical significance (70.6 ± 9.2% vs. 44.7±11.2%, P=0.06). Multivariate regression confirmed the prognostic role of the treatment group. None of the patients who underwent a single HDC/SCR developed veno-occlusive disease (VOD), while 17% of patients who underwent tandem HDC/SCR developed mild-to-severe VOD. Rates of other transplant-related acute toxicities were similar. CONCLUSION: Tandem HDC/SCR for patients with high-risk NB seems to improve survival without significant increases in acute toxicities. This needs to be validated in randomized prospective trials.
Subject(s)
Induction Chemotherapy , Neuroblastoma/therapy , Stem Cell Transplantation , Adolescent , Child , Child, Preschool , Combined Modality Therapy , Female , Humans , Induction Chemotherapy/adverse effects , Infant , Male , Multivariate Analysis , Retrospective Studies , Stem Cell Transplantation/adverse effects , Survival Analysis , Young AdultABSTRACT
PURPOSE: The purpose of this research was to determine if standing dynamic balance was affected by carrying a backpack. SUBJECTS: Data was obtained from 50 healthy college students. MATERIALS AND METHODS: Limits of stability was assessed using the Smart Equitest Balance Master System(R). Reaction time, movement velocity, end point excursion, maximum excursion, and directional control were measured to evaluate movement, with and without a loaded backpack. DATA ANALYSIS: Reliability was established using an Intra-Class Correlation Coefficient (2,1). MANOVA was utilized to analyze the effect of the backpack. SUMMARY DATA: Movement velocity significantly decreased during backpack loaded trials (p=0.004). Directional control was significantly different with respect to direction (p=0.006). No significant difference in reaction time, maximum excursion, or end point excursion was observed with backpack loading (p=0.10-0.93). CONCLUSION: This study concludes that backpack load carrying has an effect on movement velocity and directional control.
