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Survival after high-dose chemotherapy for refractory and recurrent Ewing sarcoma

Windsor, Rachael; Hamilton, Anthony; McTiernan, Anne; Dileo, Palma; Michelagnoli, Maria; Seddon, Beatrice; Strauss, Sandra J; (2022) Survival after high-dose chemotherapy for refractory and recurrent Ewing sarcoma. European Journal of Cancer , 170 pp. 131-139. 10.1016/j.ejca.2022.04.007. Green open access

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Abstract

BACKGROUND: outcome of primary refractory or recurrent Ewing sarcoma (RRES) is poor and the role of high-dose therapy (HDT) remains uncertain. We retrospectively reviewed all patients treated for RRES in the London Sarcoma Service (LSS) over a 22-year period with the aim of adding to the current literature and developing a prognostic risk score to aid clinical decision-making. METHODS AND RESULTS: One hundred and ninety-six patients were included; 64 patients received HDT, 98 standard non-HDT chemotherapy and 34 no systemic therapy. At RRES, median age was 20 years and seventy-four per cent of patients had progressed or relapsed within 24 months. Median overall survival for HDT and non-HDT patients was 76 months (95% CI 34.8-117.2) and 10.5 months (95% CI 8.9-12.1), respectively. Two and five-year post-relapse survival (PRS) for HDT patients was 67.9% (SE 5.9) and 52.7% (SE 6.5), and for non-HDT patients, 20.5% (SE 4.2) and 2% (SE 1.5). Four prognostic factors significant on multivariate analysis were assigned a score of one point each, creating good (score 0), intermediate (score 1-2) and poor (score 3-4) prognosis groups. The increased score was significantly associated with reduced PRS. CONCLUSION: Our study demonstrates that in RRES, HDT is associated with superior outcomes compared with non-HDT chemotherapy. RRES patients can be risk-stratified according to a predictive prognostic index we have developed, with the potential benefit of HDT observed even in patients with poor prognostic scores.

Type: Article
Title: Survival after high-dose chemotherapy for refractory and recurrent Ewing sarcoma
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ejca.2022.04.007
Publisher version: https://doi.org/10.1016/j.ejca.2022.04.007
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Autologous stem-cell transplant, Ewing, Sarcoma
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > Research Department of Oncology
URI: https://discovery.ucl.ac.uk/id/eprint/10151811
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