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Annals of Oncology Advance Access published online on June 16, 2006
Annals of Oncology, doi:10.1093/annonc/mdl108
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© 2006 European Society for Medical Oncology
Received February 27, 2006
Revised April 3, 2006
Accepted April 12, 2006

original article

High dose chemotherapy with bone marrow or peripheral stem cell rescue is an effective treatment option for patients with relapsed or progressive Ewing's sarcoma family of tumours

A. McTiernan 1, D. Driver 1, M. P. Michelagnoli 1, A. M. Kilby 1, and J. S. Whelan 1 *

1 Department of Oncology, UCL Hospitals NHS Foundation Trust, London, UK

* To whom correspondence should be addressed.
J. S. Whelan, E-mail: jeremy.whelan{at}uclh.org


  Abstract

Background: The outcome for patients with recurrent or progressive Ewing's sarcoma family of tumours (ESFT) is poor. High dose therapy (HDT) has been used for a number of years in an attempt to improve survival; however, evidence for the efficacy of this treatment remains limited.

Patients and methods: Between 1992 and 2004, 33 patients with recurrent or progressive ESFT were treated with HDT with bone marrow (n = 2), peripheral blood stem cell (n = 30), or bone marrow and peripheral blood stem cell support (n = 1), at a single institution. HDT was with busulphan and melphalan in 22 patients; melphalan and etoposide in seven patients, three with total body irradiation (TBI); melphalan in three patients (2 with TBI), and busulphan and cyclophosphamide in one patient.

Results: The 2 and 5 year event free survival was 42.5% (95% CI, 26-59%) and 38.2% (95% CI, 21-55%) respectively. There was one treatment related death from colitis, and grade 4 infection was observed in two patients.

Conclusions: Long-term survival can be attained in patients with recurrent or refractory ESFT treated with HDT. However, this treatment is associated with severe toxicity. A need remains for prospective randomised clinical trials of HDT in this group of patients.

Keywords: Ewing's sarcoma; high dose therapy; PNET.
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