Autologous Bone Marrow Transplantation - Blog Science Connections

582 Busulfan + Cyclophosphamide in Childhood Cancer
PATIENTS AND METHODS
Patients' Characteristics
Thirty patients entered this study. Their median age at diagnosis was 8
years (range, 1.5-20 years), and their sex ratio was two males to one female.
Eleven children had neuroblastoma, eight non-Hodgkin's lymphoma, six
Ewing's sarcoma, and five rhabdomyosarcoma.
Before entering this phase II study, all patients had been extensively
treated. They had received 3-10 different drugs (median, 6 drugs), for a
median duration of 11 months (range, 3-50 months). Surgical excision of
the primary had been attempted in 10 of 11 with neuroblastoma, of 8 with
non-Hodgkin's lymphoma, 1 of 6 with Ewing's sarcoma, and 4 of 5 with
rhabdomyosarcoma. Radiation therapy had been previously administered to
three of six Ewing's sarcoma primary tumors and to primary and metastatic
lymph nodes of one of the patients with rhabdomyosarcoma. Nine of the 30
patients had also previously received high-dose cyclophosphamide with
autologous bone marrow transplantation (ABMT); conditioning regimens
included a combination of melphalan (180 mg/m 2 ) with VM-26 (teniposide),
BCNC1 (carmustine), and, for some patients, procarbazine. Despite the use of
such aggressive therapies, at the time of entering this phase II study, 14
patients had primarily refractory disease, 14 were in their first progressive
relapse, and 2 were in the second progressive relapse (see Table 1).
Bone Marrow Procedures
Twenty-eight patients had an ABMT, and two had a human leukocyte
antigen-matched allogeneic BMT. The technique of bone marrow harvesting
has been described elsewhere (6). Samples of harvested bone marrow were
cytologically proved to be free of residual involvement. All harvested bone
marrow was cryopreserved in dimethyl sulfoxide as previously described (7).
Twelve out of 28 bone marrow harvests were purged by Asta Z 100 ptmol/ml
(Beaujean et al, unpublished data). This purging technique was used for the
majority of the harvests taken from patients who had bone marrow involve-
Table 1. Patients' Status Before Busulfan and Cyclophosphamide
Primarily Resistant First Progressive Second Progressive
Diagnosis Disease Relapse Relapse
Neuroblastoma 6 5
Non-Hodgkin's
lymphoma
4 4
Rhabdomyosarcoma 2 2 1
Ewing's sarcoma 2 3 1
Total 14 14 2