Abstract
High-dose multiagent chemotherapy followed by autologous bone marrow rescue was used in the treatment of 10 patients (6 neuroblastomas, 1 Ewing's sarcoma, 1 Wilms' tumor, 1 rhabdomyosarcoma, 1 malignant sacrococcygeal teratoma) with Stage III or IV childhood tumors. Except for one early death case and a teratoma that obtained complete remission due to other chemotherapy, all of the other cases have relapsed, and the response remained transient. The dose of nucleated marrow cells collected by aspiration varied from 2.4 to 6.8 × 108 /kg, and infused mononuclear cells ranged from 0.5 to 12 × 107 /kg. The patients were kept in a laminar flow unit, and gut decontamination was carried out using Vancomycin, Aminoglycoside, Sulfamethoxazole-Trimethoprim, and Amphotericin B. Marrow reconstitution was obtained in all the patients except a case of neuroblastoma who died on the day of autograft, with recovery of leucocyte counts to > 1.0 × 109 /l between 8 and 36 days and granulocyte recovery > 0.5 × 109 /l between 13 and 52 days. Melphalan showed a tendency for delayed bone-marrow reconstitution. Neither graft-versus-host disease nor interstitial pneumonitis occurred. High-dose chemotherapy combined with autologous marrow grafting is a tolerable treatment method for advanced tumors in children, but further study is required to determine whether the procedure is of sufficient value.
