Researchers from the Fred Hutchinson Cancer Research Center (FHCRC) have reported that high-dose chemotherapy and autologous stem cell transplantation may improve survival in patients with chemotherapy response relapse of Ewing’s sarcoma.[1] Similar findings were also reported by French researchers.[2]

The Ewing’s sarcoma family of tumors is sensitive to chemotherapy, but once relapse occurs cure is difficult to achieve. The role of high-dose chemotherapy for Ewin’s sarcoma has been controversial but utilized by most groups treating children and adults. The report from the FHCRC looked at the outcomes of 55 consecutive patients who were treated for a relapse of Ewing’s sarcoma between 1985 and 2002. The median age of patients in this study was 13.5 years and the oldest patient was 20 years old. A total of 39 patients had metastatic disease, 10 had both local and metastatic disease and six had local recurrence. Thirteen patients with response relapse had an autologous stem cell transplant. Nine of the 13 patients in this study received tandem transplants and most received total body irradiation or total bone irradiation regimen. The five year survival of chemotherapy response patients was 46% versus 0% for those that did not respond. Overall survival of responsive patients receiving an autologous transplant was 75% for transplant recipients and 20% for non-transplant recipients. Patients who had a relapse-free interval greater than two years also had an improved survival.

The French study reviewed the outcomes of 46 adult patients treated with high-dose chemotherapy and autologous stem cell transplantation between 1987 and 2000. The median age of this study population was 21 years with the oldest patient being 46 years old. The median follow-up of this study was seven years. They reported a five year overall survival of 63% and a progression-free survival of 47%. Six of the nine patients receiving tandem transplants and two of four receiving a single transplant are alive. Poor prognostic factors in this study were a poor response to salvage chemotherapy and metastatic disease at diagnosis. There were no treatment-related deaths in either study.

Comments: These two studies show that patients with Ewing’s sarcoma who have chemotherapy responsive relapse benefit from an autologous stem cell transplant. There is currently no consensus on the most effective high-dose regimen or whether or not these patients would benefit from tandem or sequential transplants. However, long-term survival in six of nine recipients of tandem transplants in the FHCRC study is of interest.

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