Autologous peripheral blood stem cell transplantation and high-dose chemotherapy with thiotepa and melphalan for high-risk medulloblastoma with cancerous meningitis

Abstract

Here, we describe the case of a 4-year-old boy with cerebellar vermis tumor, which was diagnosed as medulloblastoma (classic medulloblastoma with desmoplasia, WHO grade IV, Chang stage classification M1). Following one course of chemotherapy, he developed cancerous meningitis. Therefore, we performed intrathecal injection (IT) of methotrexate (MTX)+dexamethasone (DEX) once/week for 3 weeks until the cerebrospinal fluid cytology results became negative. The patient underwent (1) chemotherapy (four courses), (2) radiotherapy (craniospinal irradiation, 24 Gy; focal irradiation, 51.2 Gy), and (3) high-dose chemotherapy with thiotepa (TEPA)+melphalan (MEL) combined with autologous stem cell transplantation. Maintenance therapy with oral etoposide was also administered. The patient was found to be surviving without relapse at 49 months after diagnosis. It is suggested that treatment by IT of MTX+DEX and high-dose chemotherapy with TEPA+MEL combined with autologous stem cell transplantation can be expected to have significant therapeutic effects on high-risk medulloblastomas with cancerous meningitis.