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In the MB cohort, the mean age was 2.5\u00a0years, 13 were male. Gross total resection (GTR) was achieved in 18 patients; 15 had non-metastatic disease (M0). Among non-MB patients, the mean age was 2.7\u00a0years, 11 were female. Nine patients had GTR; 12 had M0. According to the MB molecular subgroup, the 2- and 5-year event-free survival (EFS) rates for the SHH subgroup were 76.9%, and overall survival (OS) was 92.3%. For the non-WNT\/non-SHH subgroup, the 2- and 5-year EFS rates were 33.3% and 22.2%, and OS, 66.7% and 55.6%, respectively. Two SHH and five non-WNT\/non-SHH patients were successfully salvaged with craniospinal irradiation after a mean of 12\u00a0months (range, 7\u201336\u00a0months). Among non-MB patients, the 2- and 5-year EFS and OS were 28.6\/19.0% and 42.9\/32.1%, respectively. All patients developed grade 3\u20134 mucositis\/typhlitis and febrile neutropenia and 13.9% invasive fungal infections during HDCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HDCT\/ASCR is feasible in a middle-income country setting and provides favorable outcomes in SHH medulloblastoma. However, prognosis remains poor for non-SHH MB and other embryonal tumors, highlighting the need for novel molecularly guided therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00381-026-07367-w","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T23:51:08Z","timestamp":1782863468000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["High-dose chemotherapy with autologous stem cell rescue in children under 5\u00a0years of age with central nervous system embryonal tumors: results from a prospective cohort in an upper-middle-income country"],"prefix":"10.1007","volume":"42","author":[{"given":"Andrea Maria","family":"Cappellano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7505-261X","authenticated-orcid":false,"given":"Nat\u00e1lia","family":"Dassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francine Tesser","family":"Gamba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Gottardello","family":"Zecchin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata Fittipaldi","family":"da Costa Guimar\u00e3es","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Seber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui Manuel","family":"Reis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Carolina","family":"dos Santos Torquato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica Benigno","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murilo","family":"Bonatelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia Alessandra","family":"Dastoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos Devanir Silva","family":"da Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Cavalheiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronaldo Modesto","family":"de Souza Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederico Adolfo","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia Regina Caminada","family":"de Toledo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasjla Saba","family":"Da Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"issue":"3","key":"7367_CR1","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1080\/14737159.2020.1714439","volume":"20","author":"BK Li","year":"2020","unstructured":"Li BK, Al-Karmi S, Huang A, Bouffet E (2020) Pediatric embryonal brain tumors in the molecular era. 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