{'fraction_non_alphanumeric': 0.053610503282275714, 'fraction_numerical': 0.03938730853391685, 'mean_word_length': 4.715625, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Up-front melphalan in Ewing's family tumors with bone/bone marrow metastases at onset (very-high risk EFTs). A report from ISG/AIEOP "Very High Risk EFTs Cooperative Study".

9037 Background:Patients with very-high risk EFTs have a poor prognosis. Melphalan (L-PAM) has been widely used in myeloablative regimens in EFTs, without a prior demonstration of its effectiveness in this disease.


METHODS
From March 2001, a study was opened for very-high risk EFTs with the main aim to investigate the activity and toxicity of up-front L-PAM at non myeloablative doses. Treatment consisted of initial window-therapy with L-PAM (50 mg/m2 every 21 days × 2 courses) followed by 8 intensive chemotherapy courses, and consolidation with megatherapy+autologous PBSC rescue. PBSC collection was scheduled in responders after the 4th/6th chemotherapy course. Surgery and radiotherapy were employed on individual basis Results: As of September 2003, 17 consecutive patients (median age 16yrs, range 9-34) were enrolled. All patients were evaluable for toxicity and up-front L-PAM activity. No severe toxicities were reported, but for grade 3-4 hemopoietic toxicity. After L-PAM courses, grade 4 neutropenia, thrombocytopenia, anemia were registered in 76%, 68%, and 41% of cases, respectively. Responses after the up-front phase according to the RECIST criteria were as follows: 13/17 (76%) PR, 2/17 (12%) SD, 2/17 (12%) PD. Up to date 13 patients were evaluable for PBSC collection. Ten/13 (77%) mobilized PBSC adequately, and the median harvest was 5 × 106 CD34+/kg (range 2.6 -15 × 106).


CONCLUSIONS
L-PAM proved to be active. Toxicity was predictable and manageable. Moreover, the scheduled L-PAM doses allowed PBSC collection even after further intensive chemotherapy in most cases. No significant financial relationships to disclose.