HIGH-DOSE SEQUENTIAL CHEMOTHERAPY AND AUTOLOGOUS STEM-CELL REINFUSIONIN ADVANCED PEDIATRIC SOLID TUMORS

Between January 1993 and December 1996, 21 children with advanced soli d tumors were entered in a dose-escalating study of high-dose sequenti al chemotherapy followed by autologous stem cell transplantation. The diagnoses included neuroblastoma (NB) for 13 patients; Ewing's sarcoma (ES) for six patients and osteosarcoma for two patients, Nine patient s received therapy as consolidation for primary metastatic disease, an d 12 patients had had previous relapses, Treatment consisted of CY giv en i.v. at a dose of 7 g/m(2) on day 1, followed by G-CSF until myeloi d recovery, After 3 weeks of rest, all patients were given thiotepa i. v. on days 22-24. The total dose of thiotepa was 450 mg/m(2) in three patients, 600 mg/m(2) in six patients, and 750 mg/m(2) in 12 patients, Melphalan was given i.v. at a dose of 180 mg/m(2) i.v. on day 27 foll owed by stem cell infusion on day 28, Major toxic reactions included s tomatitis, esophagitis, diarrhea and dermatitis, Three patients died o f treatment-related complications, Twelve patients have had a relapse, Six patients (five with NB and one with ES) are alive in continuous r emission 5-50 months (median 36) after transplantation. The results of this study show that it is feasible to administer high-dose sequentia l chemotherapy to children with advanced solid tumors.