Reduced-Intensity Allogeneic Stem Cell Transplantation in Children and Young Adults with Ultrahigh-Risk Pediatric Sarcomas Kristin Baird, Terry J. Fry,

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Reduced-Intensity Allogeneic Stem Cell Transplantation in Children and Young Adults with Ultrahigh-Risk Pediatric Sarcomas Kristin Baird, Terry J. Fry, Seth M. Steinberg, Michael R. Bishop, Daniel H. Fowler, Cynthia P. Delbrook, Jennifer L. Humphrey, Alison Rager, Kelly Richards, Alan S. Wayne, Crystal L. Mackall Biology of Blood and Marrow Transplantation Volume 18, Issue 5, Pages 698-707 (May 2012) DOI: 10.1016/j.bbmt.2011.08.020 Copyright © 2012 Terms and Conditions

Figure 1 Immune recovery. Median cell count recovery of lymphocyte subsets over time. The “Post” time point reflects cell counts following EPOCH-F cycles. Day 0 reflects cell counts on the day of transplantation following the preparative regimen, where effective immune depletion was achieved and reflected by mean CD 4 counts of 0. Patients achieved normal levels by 6 months posttransplantation and sustained these levels over time (norms are represented by dashed lines). Biology of Blood and Marrow Transplantation 2012 18, 698-707DOI: (10.1016/j.bbmt.2011.08.020) Copyright © 2012 Terms and Conditions

Figure 2 Clinical outcomes. Overall survival (OS) Kaplan-Meier survival curves are shown for: (A) all patients enrolled on study; showing patients who were transplant and nontransplanted. (B) Comparison of survival from transplantation for NED patients versus those with overt disease at transplantation (P = .074). (C) Survival post-alloHSCT based upon high-risk clinical characteristics (P = NS). (D) Survival post-alloHSCT based upon histology (P = NS). Biology of Blood and Marrow Transplantation 2012 18, 698-707DOI: (10.1016/j.bbmt.2011.08.020) Copyright © 2012 Terms and Conditions

Figure 3 Prolonged survival despite early posttransplantation relapse. Survival (months) for individual patients are shown by horizontal bars. Patients not receiving alloHSCT (red) have short survivals following relapse, whereas transplanted patients (blue, green) experienced prolonged survival following relapse. Patients in green represent surviving patients (only #21 has not relapsed). ∗Patient #17 died of bronchiolitis obliterans following posttransplantation lung irradiation. Biology of Blood and Marrow Transplantation 2012 18, 698-707DOI: (10.1016/j.bbmt.2011.08.020) Copyright © 2012 Terms and Conditions

Figure 4 Indolent growth of recurrent Ewing’s sarcoma following alloHSCT. Patient #15 showed persistent disease at the first posttransplantation restaging (day 42). No systemic therapy was administered because of patient choice, and he showed minimal progression of disease over an 8-month period. Biology of Blood and Marrow Transplantation 2012 18, 698-707DOI: (10.1016/j.bbmt.2011.08.020) Copyright © 2012 Terms and Conditions