How do you incorporate high-dose chemotherapy with autologous stem cell rescue for a patient with relapsed, metastatic Ewing sarcoma?

There are older single-arm studies indicating that incorporating autologous transplant into the treatment of relapsed Ewing sarcoma can lead to a 20-30% survival rate. Usually, a patient receives up to 3-5 rounds of reinduction with standard chemotherapy, followed by consolidation with autotransplant and then additional radiation. Transplant conditioning may include regimens such as BuMelThio which is quite toxic or just BuMel.

Over the last 20 years, I have transplanted 6-10 such patients with 2 being longer-term survivors.

There is no randomized study, to my knowledge, that explored this in all comers, thus the published transplant groups tend to be selected based on better response to chemotherapy following relapse. Published studies a...

I agree. I have transplanted over years 8-10 transplants in this situation. A couple of them actually before relapse. To begin with, they were metastatic and bad prognostic, 3 of them who were transplanted in CR3 are all long term survivors.

I think the role of transplant is more (increased successes) in CR1 than the subsequent one.