Journal Article

DKFZ-2025-02357

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Haematotoxicity of Craniospinal Radiochemotherapy for Metastatic Paediatric High-Grade Glioma.

Valentini, C. ; Perwein, T. ; Bison, B. ; Gielen, G. H. ; Knerlich-Lukoschus, F. ; Bock, H. C. ; Seidel, C. ; Kortmann, R. D. ; Sturm, D.DKFZ* ; Benesch, M. ; Nussbaumer, G. ; Krischer, J. M. ; V Bueren, A. ; Eyrich, M. ; Friker, L. L. ; Hoffmann, M. ; Gkika, E. ; Wittig-Sauerwein, A. ; Hörner-Rieber, J. ; Schwarz, R. ; Jablonska, K. ; Hoffmann, W. ; Vordermark, D. ; Rieken, S. ; Höng, L. ; Rödel, C. ; Timmermann, B.DKFZ* ; Fennell, J. T. ; Claviez, A. ; Karremann, M. ; Kramm, C. M. ; Krause, M.DKFZ*

2025
Saunders [Erscheinungsort nicht ermittelbar]

Abstract: Paediatric high-grade gliomas (pedHGGs) have a dismal prognosis, often characterised by early and diffuse disease progression. Novel treatment approaches are urgently needed to improve outcomes. The upcoming SIOPE-HGG (High Grade Glioma)-01 trial will investigate upfront craniospinal radiochemotherapy (CSI-RCT) for newly diagnosed, nonmetastatic diffuse midline glioma/diffuse intrinsic pontine glioma (DMG/DIPG). As CSI-RCT is frequently avoided due to concerns over haematotoxicity, real-world feasibility data are critically needed.We retrospectively assessed haematological toxicity in 19 patients (aged 3-21 years) with metastatic pedHGG treated with CSI-RCT within the hirn tumor glioblastoma trial (HIT-HGG) and hospital in trial-glioblastoma (HIT-GBM) trial programmes (2002-2024). All patients received craniospinal irradiation (median dose: 35.2 Gy) using photon- or proton-based techniques, with concurrent chemotherapy: temozolomide (TMZ; n = 14) or PEI (cisplatin, etoposide, ifosfamide; n = 5). Haematological toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0.Grade 3 to 4 haematotoxicity was observed in 7 of 19 patients (36.8%). Chemotherapy was discontinued in two cases-one due to TMZ-induced aplastic anaemia (TIAA) and another due to thrombocytopaenia. The remaining patients tolerated full-dose CSI-RCT with manageable side effects, and no unplanned radiotherapy interruptions occurred. The haematotoxicity rate was comparable to or lower than previous reports, indicating that CSI-RCT is feasible with appropriate monitoring and management.This is the largest cohort to date assessing haematological toxicity of upfront CSI-RCT in metastatic pedHGG. Despite notable haematotoxicity, treatment was largely feasible and well-tolerated. These findings support the integration of CSI-RCT into future clinical trials for newly diagnosed DMG/DIPG and provide a foundation for the upcoming SIOPE HGG-01 trial. Proton therapy may further reduce toxicity and warrants prospective evaluation.

Keyword(s): Craniospinal radiochemotherapy ; haematotoxicity ; paediatric high-grade glioma

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Contributing Institute(s):

1. B062 Pädiatrische Neuroonkologie (B062)
2. DKTK HD zentral (HD01)
3. DKTK Koordinierungsstelle Essen/Düsseldorf (ED01)
4. DKTK Koordinierungsstelle Dresden (DD01)

Research Program(s):

1. 312 - Funktionelle und strukturelle Genomforschung (POF4-312) (POF4-312)

Appears in the scientific report 2025

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Database coverage:
; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Ebsco Academic Search ; Essential Science Indicators ; IF < 5 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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