High-Dose Chemotherapy Plus Autologous Stem Cell Transplantation Compared With Intermediate-Dose Chemotherapy Plus Autologous Stem Cell Transplantation With or Without Isotretinoin in Treating Young Patients With Recurrent High-Grade Gliomas
Brain Tumor, Central Nervous System Tumor
About this trial
This is an interventional treatment trial for Brain Tumor focused on measuring childhood high-grade cerebral astrocytoma, recurrent childhood cerebellar astrocytoma, recurrent childhood cerebral astrocytoma
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed diagnosis of 1 of the following high-grade gliomas: Glioblastoma multiforme Anaplastic astrocytoma Gliosarcoma Disease in first relapse No primary brainstem or spinal cord gliomas No secondary glioblastomas arising after prior treatment for a non-glial tumor Prior local radiotherapy of 5,000-6,000 cGy required Less than 1.5 cm of residual gadolinium-enhancing tumor in maximal cross-sectional diameter by MRI No metastatic tumor by spinal MRI PATIENT CHARACTERISTICS: Age Under 21 at diagnosis Performance status Lansky 50-100% OR Karnofsky 50-100% Life expectancy Not specified Hematopoietic Absolute neutrophil count ≥ 500/mm^3 Platelet count ≥ 100,000/mm^3 (transfusion independent) Hepatic Bilirubin ≤ 1.5 times upper limit of normal (ULN) AST or ALT < 2.5 times ULN Renal Glomerular filtration rate ≥ 60 mL/min AND/OR Creatinine clearance ≥ 60 mL/min Cardiovascular Shortening fraction ≥ 27% by echocardiogram OR Ejection fraction ≥ 50% by MUGA Pulmonary No dyspnea at rest No exercise intolerance Pulse oximetry > 94% Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: Biologic therapy Not specified Chemotherapy More than 4 weeks since prior chemotherapy No prior thiotepa No prior myeloablative chemotherapy Endocrine therapy No concurrent corticosteroids Radiotherapy See Disease Characteristics More than 8 weeks since prior radiotherapy No prior craniospinal radiotherapy Surgery Not specified
Sites / Locations
- Arkansas Cancer Research Center at University of Arkansas for Medical Sciences
- Children's Hospital and Research Center - Oakland
- University of California Davis Cancer Center
- Children's Hospital and Health Center - San Diego
- Children's Hospital Cancer Center
- Children's National Medical Center
- University of Florida Shands Cancer Center
- Nemours Children's Clinic
- University of Miami Sylvester Comprehensive Cancer Center
- Miami Children's Hospital
- All Children's Hospital
- St. Joseph's Cancer Institute at St. Joseph's Hospital
- Kaplan Cancer Center at St. Mary's Medical Center
- Emory University Hospital - Atlanta
- Cancer Research Center of Hawaii
- Indiana University Cancer Center
- St. Vincent Indianapolis Hospital
- Kosair Children's Hospital
- CancerCare of Maine at Eastern Maine Medial Center
- Floating Hospital for Children at Tufts - New England Medical Center
- Barbara Ann Karmanos Cancer Institute
- Spectrum Health Cancer Care - Butterworth Campus
- Van Elslander Cancer Center at St. John Hospital and Medical Center
- Children's Hospital of Minnesota - Minneapolis
- Fairview University Medical Center - University Campus
- University of Mississippi Medical Center
- Children's Mercy Hospital
- Siteman Cancer Center at Barnes-Jewish Hospital
- Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
- Roswell Park Cancer Institute
- NYU Cancer Institute at New York University Medical Center
- Herbert Irving Comprehensive Cancer Center at Columbia University
- James P. Wilmot Cancer Center at University of Rochester Medical Center
- SUNY Upstate Medical University Hospital
- New York Medical College
- Children's Hospital Medical Center of Akron
- Cincinnati Children's Hospital Medical Center
- Rainbow Babies and Children's Hospital
- Columbus Children's Hospital
- Children's Medical Center - Dayton
- Oklahoma University Medical Center
- Penn State Cancer Institute at Milton S. Hershey Medical Center
- Hollings Cancer Center at Medical University of South Carolina
- Sioux Valley Hospital and University of South Dakota Medical Center
- Cook Children's Medical Center - Fort Worth
- Covenant Children's Hospital
- Primary Children's Medical Center
- INOVA Fairfax Hospital
- Children's Hospital of the King's Daughters
- Massey Cancer Center at Virginia Commonwealth University
- University of Wisconsin Comprehensive Cancer Center
- Marshfield Clinic - Marshfield Center
- Princess Margaret Hospital for Children
- Children's & Women's Hospital of British Columbia
- McMaster Children's Hospital at Hamilton Health Sciences
- Hospital for Sick Children
- Montreal Children's Hospital at McGill University Health Center
- Hopital Sainte Justine
- Centre Hospitalier Universitaire de Quebec
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Experimental
Experimental
Experimental
No Intervention
Arm I (high-dose chemotherapy and ASCR)
Arm II (intermediate-dose chemotherapy and ASCR)
Arm III (isotretinoin)
Arm IV (no isotretinoin)
Patients receive high-dose chemotherapy comprising carboplatin IV over 4 hours on days -8 to -6; thiotepa IV over 3 hours and etoposide IV over 3 hours on days -5 to -3; and filgrastim (G-CSF) IV or SC once daily beginning on day 1 and continuing until blood counts recover. Autologous PBSC or bone marrow are reinfused on day 0.
Patients receive intermediate-dose chemotherapy comprising carboplatin IV over 4 hours and thiotepa IV over 3 hours on days 1-2 and G-CSF IV or SC once daily beginning on day 4 and continuing until blood counts recover. Autologous PBSC or bone marrow are reinfused on day 3. Treatment repeats every 28 days for a total of 3 courses.
Patients receive oral isotretinoin twice daily on days 1-14. Treatment repeats every 28 days for a total of 6 courses.
Patients do not receive maintenance therapy.