title: 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.
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.
  
  
  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.
authors.affiliation: Department of Oncology, UCL Hospitals NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: McTiernan
authors.forename: D
authors.initials: D
authors.lastname: Driver
authors.forename: M P
authors.initials: MP
authors.lastname: Michelagnoli
authors.forename: A M
authors.initials: AM
authors.lastname: Kilby
authors.forename: J S
authors.initials: JS
authors.lastname: Whelan
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D016026:Bone Marrow Transplantation; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D002066:Busulfan / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D018450:Disease Progression; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D012512:Sarcoma, Ewing / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D002066:Busulfan; D008558:Melphalan