Survival Outcomes After ICE-Based High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Metastatic Osteosarcoma

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Abstract
Aim: Metastatic osteosarcoma remains associated with poor survival despite multimodal therapy. High-dose chemotherapy followed by autologous stem cell transplantation (HDCT+ASCT) has been explored as a treatment intensification strategy; however, robust real-world data remain limited. This study aimed to evaluate treatment response and survival outcomes in patients with metastatic osteosarcoma treated with ICE-based HDCT followed by ASCT in a real-world setting.Materials and Methods: In this retrospective single-center cohort study, 46 patients with metastatic osteosarcoma who received ICE-based HDCT followed by ASCT were analyzed. Tumor response was assessed according to RECIST criteria. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Univariable and multivariable Cox regression analyses were performed to evaluate associations between baseline clinical characteristics and survival outcomes.Results: The median age was 23,5 years, and 34 patients (73.9%) were male. The objective response rate (ORR) was 28.3%, and disease control (CR+PR+SD) was achieved in 52.2% of patients. Median PFS was 3.5 months (IQR: 2.6–6.0), and median OS was 10.7 months (IQR: 8.8–14.9). Survival curves demonstrated early attrition followed by a plateau phase. Exploratory analyses indicated longer OS in patients with ECOG 0–1 and lung-only metastases. No treatment-related mortality was observed.Conclusions: ICE-based HDCT followed by ASCT demonstrates measurable antitumor activity in metastatic osteosarcoma. However, given the limited median PFS and absence of a comparative control group, this approach should be considered a selective intensification strategy rather than a standard salvage therapy, and careful patient selection remains essential.

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