{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T19:57:56Z","timestamp":1790971076387,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Although the survival rates of patients with localized osteosarcoma have significantly improved, metastatic osteosarcoma still has a poor prognosis. The role of high\u2010dose chemotherapy and autologous stem cell transplantation (HDC\/ASCT) in high\u2010risk osteosarcoma remains unclear compared to that of conventional chemotherapy, and an optimal conditioning regimen remains unestablished. We retrospectively analyzed the outcomes of tandem HDC\/ASCT in patients newly diagnosed with osteosarcoma and pulmonary metastasis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Among patients with osteosarcoma treated at Seoul National University Children's Hospital between January 2014 and May 2024, 11 underwent tandem HDC\/ASCT for pulmonary metastases at diagnosis. We used melphalan, etoposide, and carboplatin as the first HDC and busulfan plus melphalan as the second.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age at diagnosis was 12.2 years (range, 6.5\u201313.8), and the median follow\u2010up duration was 57.4 months (range, 5.9\u2013112.9). All the patients achieved engraftment after HDC\/ASCT. The 5\u2010year event\u2010free and overall survival (EFS) were 41.6% and the overall survival (OS) was 68.2%, respectively. Relapse occurred in four patients (36.4%), all of whom received salvage chemotherapy. Among the four deaths (36.4%), two were due to treatment\u2010related mortality (one veno\u2010occlusive disease [VOD] and one therapy\u2010related myelodysplastic syndrome) and two were due to the progression of osteosarcoma. No severe complications were observed during the initial HDC\/ASCT procedure. However, during the second HDC\/ASCT, four patients (36.4%) were treated for severe VOD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Compared to historical data, tandem HDC\/ASCT could be considered a treatment option for osteosarcoma patients with pulmonary metastases. However, considering toxicity, modifications to the conditioning regimen are necessary.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.31914","type":"journal-article","created":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T05:33:18Z","timestamp":1752903198000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tandem High\u2010Dose Chemotherapy and Autologous Stem Cell Transplantation for Osteosarcoma With Initial Pulmonary Metastases"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7062-0414","authenticated-orcid":false,"given":"Hyun Jin","family":"Park","sequence":"first","affiliation":[{"name":"Department of Pediatrics Seoul National University College of Medicine  Seoul Republic of Korea"},{"name":"Seoul National University Cancer Research Institute  Seoul Republic of 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