Autologous stem cell transplantation for pediatric solid tumors in a resource-limited setting: a single-center experience of 15 years.

INTRODUCTION

Autologous hematopoietic stem-cell transplant(ASCT) following high-dose chemotherapy is an established treatment for selected pediatric solid tumors. However, data from low- and middle-income countries(LMICs) remain scarce, where outcomes may be influenced by limited supportive care infrastructure and higher infection risks. Most available reports focus primarily on neuroblastoma, with little evidence for other solid tumors.

METHODS

The study included children, adolescents, and young adults (CAYA,0-25 years) with solid tumors treated at a tertiary-care center in India, aiming to assess survival outcomes, engraftment kinetics, and toxicities. Data were collected from patient files and electronic databases for those who underwent ASCT between January 2008 and June 2025.

RESULTS

Out of 92 patients, median age was 6y (IQR,4-16) with 69.6% males. Diagnoses included: high-risk neuroblastoma(HRNB,52.2%), relapsed/refractory Ewing sarcoma(EWS,22.8%), relapsed/refractory germ-cell tumors(GCT,15.2%), retinoblastoma(RB,5.4%), and soft-tissue sarcoma (STS,4.4%). Forty-three (46.8%) underwent ASCT in relapse/refractory setting, while 49(53.2%) had upfront ASCT. Median CD34+cell dose was 5.7(IQR,3.5-6.9) million/kg, with a median cryopreservation duration of 16(IQR,8-49) days. Median time to neutrophil-engraftment was 11(IQR,9-12) days. The 3-year OS of the entire cohort was 50.6% (95%CI: 36.8-62.9), and EFS was 35.9% (95%CI: 23.6-48.3). Three-year OS for HRNB, relapsed/refractory-EWS, relapsed/refractory-GCT, STS and RB were 48.5%(95%CI: 29.2-65.3), 43.8% (95%CI: 17.8-67.4), 56.3%(95%CI: 20.9-80.9), 66.7% (95%CI: 5.4-94.5), and 50.0%(95%CI: 6.0-91.0), respectively. For HRNB and EWS, BuMel-140 had better OS than CEM-200 [HR = 0.15,95%CI:0.04-0.7,p=0.005].

CONCLUSION

ASCT yields acceptable outcomes for selected high-risk or relapsed/refractory pediatric solid tumors in LMICs, with outcomes in GCT comparable to global standards, based on experience from a high-volume transplant center.