This site maintained by Barry Sugarman, B.S.ENGR.
Father of Alon Sugarman, Diagnosed March 6, 1998
with Ewing's Sarcoma of the Distal Femur.
E-Mail to:
barry@cureourchildren.org
**This guide has been written for educational
purposes only, it cannot be used for diagnosing
or treating a health problem or a disease. If you have or suspect that you or
your child may have a health problem, you should consult your doctor.**
High dose chemotherapy and Peripheral Blood Stem Cell Transplant (PBSCT) is now the standard of care with metastatic, relapsed, or chemotherapy resistant Ewing's Sarcoma and other similar tumors.
First, Apheresis, which is stem cell collection occurs. This is generally accomplished by placement of a catheter in the leg, and attachment to a collection apparatus. The procedure is similar to blood or platelet donation in that there is no pain during the procedure. Collection normally takes place over a period of one to 5 days. Neupogen®, a product by Amgen which is also called Granulocyte Colony Stimulating Factor (G-CSF) is generally given to stimulate stem cell production.
The device used to collect stem cells is manufactured by Gambro® BCT formerly Cobe BCT. Stem cells are frozen and preserved, and may be kept indefinitely. A picture of the actual apheresis machine is here.
Autologous Stem Cell Transplants: A Handbook for Patients (April 2000)
The Lymphoma Info Network Bone Marrow and Stem Cell Transplant Page
Autologous Transplantation: Basic Concepts and Controversies
Columbia Presbyterian Lymphoma Tandem Transplant Clinical Trials
First Transplant: 3 days of Carboplatin utilizing the Calvert formula, 7 times the area under the curve, and two days of melphalan at 70 mg/m2 followed by a day of rest and then the stem cell infusion.
Second Transplant: 4 days of Busulfan 1 mg/kg, and 1 day of melphalan 140 mg/m2 followed by a day of rest and then the stem cell infusion.
Zofran (for nausea), Kytril (for nausea), fluconazole (antifungal), Levofloxacin (antibiotic), Sulfamethoxazole with Trimethoprim (antibiotic), Acyclovir (antiviral), Amphotericin B (antifungal), Ceftazidime (antibiotic), Clindamycin, Gentamycin, Vancomycin, Imipenim (antibiotic), Morphine (for mouth pain), Nystatin (for oral thrush), Mycelex Troche (for oral thrush), Biotin Mouth Wash (to keep mouth clean), Total Parentaral Nutrition - TPN (IV food substitute), heparin (to prevent veno-occlusive disease), Dilantin (to prevent seizures from the Busulfan), hydrocortisone (premedication for Amphoterecin B and Stem Cell Infusion), benadryl (premedication for Amphoterecin B and Stem Cell Infusion), pepcid (to prevent excess stomach acid), metronidazole (antibiotic), red blood cell transfusions, and platelet transfusions
High-dose busulphan/melphalan with autologous stem cell rescue in Ewings Sarcoma by authors: Atra A, Whelan, JS, Calvagna V, Shankar AG, Ashley S, Shepard V, Souhami RL, Pinkerton CR. Facility: Department of Pediatric Oncology, The Royal Marsden NHS Trust, Sutton, Surrey, UK. Article Citation: Bone Marrow Transplant 1997 Nov;20(10):843-6.
Autologous
stem cell transplantation for high-risk pediatric solid tumors. by authors:
Perentesis J, Katsanis E, DeFor T, Neglia J, Ramsay N. Facility: Bone Marrow Transplantation
Program, Department of Pediatrics and Cancer Center, University of Minnesota,
Minneapolis, MN, USA. Article Citation: Bone Marrow Transplant 1999
Sep;24(6):609-15.
Double-alkylator
non-total-body irradiation regimen with autologous hematopoietic stem-cell
transplantation in pediatric solid tumors. by authors: Ozkaynak MF, Matthay
K, Cairo M, Harris RE, Feig S, Reynolds CP, Buckley J, Villablanca JG, Seeger
RC. Facility: Department of Pediatrics, New York
Medical College, Valhalla 10595,
USA. mehme1_02Kayaak@nymc.edu.
Article Citation: J Clin Oncol 1998 Mar;16(3):937-44.
Tandem high-dose therapy in rapid sequence for children with high-risk neuroblastoma. by authors Grupp SA, Stern JW, Bunin N, Nancarrow C, Ross AA, Mogul M, Adams R, Grier HE, Gorlin JB, Shamberger R, Marcus K, Neuberg D, Weinstein HJ, Diller L. Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, USA. Email: grupp@email.chop.edu.