Comparison of the treatment results after conventional and myeloablative chemotherapy in patients with poor prognosis Ewing's sarcoma family tumors - single center experience.

PURPOSE: To compare the survival of patients with poor prognosis Ewing's sarcoma family tumors (EFT) after conventional and myeloablative chemotherapy treated at our hospital in a period of 25 years. METHODS: Fifty-seven patients were treated between 1985 and 2010. The patients were separated into 3 groups. Group A included patients (n=20) treated with conventional chemotherapy between 1985 and 1997. Group B patients (n=22) were treated with conventional chemotherapy protocols between 1997 and 2010; and group C patients (n=15) were treated in the same period of time with conventional chemotherapy and subsequent myeloablative chemotherapy with hematopoietic stem cell transplantation (HSCT). RESULTS: In group A patients the 5-year overall survival (OS) was 25% and the disease-free survival (DFS) 15%; in group B patients they were 27.27% and 18.8% (p=0.31) and in group C patients 33.3% and 20% (p=0.58), respectively. CONCLUSION: More intensive chemotherapy, including myeloablative chemotherapy plus HSCT, is a curative option for patients with poor-prognosis EFT, but the survival still remains unsatisfactory.

Myeloablative chemotherapy with autologous peripheral blood stem cell transplantation in patients with poor-prognosis solid tumors - Bulgarian experience.

PURPOSE: To assess the outcome of patients with refractory or relapsed solid tumors treated with myeloablative chemotherapy followed by autologous peripheral blood stem cell transplantation. PATIENTS AND METHODS: From October 1997 to March 2006, 38 transplantations were performed in 32 patients (19 children and 13 adults, 20 men and 12 women, median age 18.5 years, range 3 - 59). Six patients underwent 2 transplantations. The diagnoses were: rhabdomyosarcoma-4; Ewing's sarcoma -7; lymphoepithelioma epipharyngis -7; germ-cell tumors -6; neuroblastoma -4; pulmonary blastoma -1; breast cancer -3. The indication for high-dose chemotherapy was sensitive relapse in 17 and refractory disease in 15 patients. At the time of transplantation the state of remission was: complete remission (CR) in 10 patients; partial remission (PR) in 16 and disease progression in 6. The median number of transplanted CD34+ cells was 4.49 x 10(6)/kg of patient's body weight. High-dose chemotherapy regimens were: thiotepa, carboplatin - 1; thiotepa, cyclophosphamide - 5; ifosfamide, carboplatin, etoposide (ICE) - 18; etoposide, carboplatin - 2; etoposide, cyclophosphamide, melphalan - 2; melphalan, fludarabine - 1; melphalan, busulfan - 3; etoposide, carboplatin, ifosfamide/thiotepa, cyclophosphamide (EBDIS) - 4. RESULTS: Twenty-nine patients were engrafted and 3 died from graft failure. Transplantation-related mortality was 9%. The most important transplantation-related toxicities included mucositis (90% of the patients), fever (85%) and diarrhea (75%). With a median follow-up of 32 months (range 1-95), the median overall survival (OS) and the event-free survival (EFS) were 62 and 36 months, respectively. CONCLUSION: High-dose chemotherapy with autologous stem cell transplantation was curative for many of our patients with poor-prognosis solid tumors.