High-Dose Chemotherapy Followed by Peripheral and/or Bone Marrow Stem Cell Transplant in Patients With Advanced...

Few reports have been published on the evaluation of stem cell auto transplantation for chemosensitive sarcomas. Some suggest benefit, others do not. We present results of 24 patients with sarcoma undergoing autotransplantation at a Canadian institution.

Twenty-four patients were treated between 1988 and 1998: 23 were >/=18 years (median 27; range 12-56); genders were equal; 12 patients had Ewing's sarcoma. At diagnosis, 12 (50%) had metastatic disease. Prior to autotransplant, all had >/=1 chemotherapy regimen. Fourteen (58%) were in complete remission (CR) and seven (29%) had minimal residual disease. All received etoposide 60 mg/kg (Day -4), melphalan 140 mg/malpha(2) on (Day -3) and a stem cell reinfusion (Day 0).

Three patients (12.5%) were alive and disease-free with median follow-up of 92 months (80-142); one was alive with disease 32 months post-autotransplant. Twenty had died (disease, 17; transplant-related, 2; unknown, 1). Of the four alive, three had Ewing's sarcoma, one alveolar rhabdomyosarcoma, and all were in CR at transplant. Median time to relapse was 6 months (2-59). Sixteen of 18 (89%) relapsed within 1 year. Median overall survival was 10 months (0-137). A trend towards improved survival (P=0.07) was evident for patients in CR prior to autotransplant.

Stem cell autotransplantation does not benefit most patients with sarcoma. A subgroup of high-risk patients in CR may fare better and warrant further study.