title: The value of high-dose chemotherapy in patients with first relapsed Ewing sarcoma.
abstract: BACKGROUND
  Prognosis of patients with relapsed Ewing sarcoma (ES) is poor. The 5-year overall survival (OS) is 13%. We analyzed high-dose chemotherapy (HDtx) versus conventional chemotherapy (CHtx) in patients with relapsed ES.
  
  
  METHODS
  Data from 239 patients with first relapse, registered during 2000-2011 in the ES relapse registry of the Cooperative Ewing Sarcoma Study Group (CESS) were analyzed.
  
  
  RESULTS
  Of 239 patients, 200 received various non-HDtx second-line CHtx regimens. Seventy-three patients had additional HDtx followed by autologous stem cell rescue. The 2-year event-free survival (EFS) was 10% (SE = 0.02) in patients treated without HDtx and 45% (SE = 0.09) in patients treated with HDtx. In a second step, we focused on those patients who achieved complete remission (CR) or partial remission (PR) after four to six cycles of conventional second-line CHtx. Here, the 2-year EFS was 31% (SE = 0.08) without additional HDtx and 44% (SE = 0.09) with additional HDtx. In addition, multivariate regression analysis indicates absence of HDtx treatment, with a Hazard ratio (HR) of 2.90 (95% CI 1.41-6.0), and early relapse, with a HR of 4.76 (95% CI 2.31-9.78), as independent prognostic factors for EFS.
  
  
  CONCLUSIONS
  Additional HDtx may contribute to further reduce the risk of further events in patients who respond to conventional second-line CHtx.
authors.affiliation: Department of Pediatric Hematology and Oncology, University Hospital Münster, Westfalian Wilhelms University Münster, Munster, Germany.
authors.forename: Meybrit
authors.initials: M
authors.lastname: Rasper
authors.forename: Susanne
authors.initials: S
authors.lastname: Jabar
authors.forename: Andreas
authors.initials: A
authors.lastname: Ranft
authors.forename: Heribert
authors.initials: H
authors.lastname: Jürgens
authors.forename: Susanne
authors.initials: S
authors.lastname: Amler
authors.forename: Uta
authors.initials: U
authors.lastname: Dirksen
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate
keywords: Ewing sarcoma; busulfan; high-dose chemotherapy; relapse; treosulfan