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High dose Melphalan and autologous transplantation in children with Rhabdomyosarcoma

As soft tissue sarcoma in children is a proven indication for adjuvant chemotherapy, so, if there is any group for whom a strategy of high dose chemotherapy (above marrow death – thus the need for an autologous transplant to support the marrow) is indicated, it should be children with this disease.
 
However, in a well constructed trial involving 86 children with higher risk rhabdomyosarcoma, there was no survival advantage to adding high dose melphalan chemotherapy (and the supportive autologous transplant) to routine chemotherapy alone. There can be no basis for delivering such high dose chemotherapy to adult patients with soft tissue sarcoma at present; at least one adult trial, recently reported confirms this statement.