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3.4. Acute Toxicities There were no treatment-related mortalities. As expected, all patients experienced grade 4 myelosuppression. Toxicities are described in Table 2 and include grades 3 and 4 mucositis (n = 8 and n = 1, resp.), grade 3 diarrhea (n = 3), grades 3 and 4 hyperbilirubinemia (n = 4 [http://www.selleckchem.com/products/cobimetinib-gdc-0973-rg7420.html buy GDC-0973] and n = 2, resp.), grade 3 and grade 4 sepsis (n = 1 and n = 2, resp.), grade 3 and grade 4 hemorrhagic cystitis (n = 2 and n = 1 resp.), grade 3 vomiting (n = 3), and grade 3 hypertension (n = 1). One patient, with moderate hearing loss prior to ASCT progressed to a grade 4 hearing loss. Median time to discharge from hospital was 21 �� 6 (range 15�C37) days, at which point all toxicities except for hearing loss had reverted to [http://www.selleckchem.com/screening/natural-product-library.html www.selleckchem.com/screening/natural-product-library.html] radiotherapy (RT) with boosts to the tumor bed sites, as well as sites of bulk metastatic disease, at a median of 12 (range: 6 to 34) weeks following ASCT (Table 3). Two patients were treated with additional therapy following ASCT, one with anti-GD2 anti-idiotypic vaccine A1G4 (#14) and another with irinotecan followed by oral etoposide (#15); both patients died of PD. Table 3 Therapy following ASCT and outcomes. 3.6. Survival Fifteen patients developed PD at a median of 12.8 (range 3.1�C25.3) months after ASCT, one of whom (#1) died from complications of PD and sepsis 5 months later. Two patients (#13 and #17 Table 3) developed secondary acute myeloid leukemia (AML), 8 and 12 months after ASCT, and succumbed to this disease at 19 and 40 months after ASCT, respectively. Median time to death after relapse or development of AML was 12.4 months. Ten patients received various additional therapies following disease progression, which are detailed in Table 3. Two patients, neither of whom received any systemic therapy after [https://en.wikipedia.org/wiki/Aldosterone Aldosterone] ASCT, are currently alive without evidence of disease, 196 and 239 months after ASCT. Three-year event-free (EFS) and overall survival (OS) were 11 �� 7% and 26��10%, respectively, while 5-year EFS and OS were 11 �� 7% and 16 �� 8%, respectively. Median EFS and OS for patients in CR prior to ASCT were 13.7 �� 2.3 months and 30.1 �� 15.3 months from ASCT, respectively, while for those patients with measurable disease prior to ASCT EFS and OS were 9.1 �� 2.1 months and 18.7 �� 4.3 months, respectively. OS probability was higher for patients treated in the first CR compared to all other patients though this did not reach statistical significance (p = 0.07 for OS; p = 0.14 for EFS) in this small group of patients (Figure 1). Figure 1 Overall survival probabilities of patients in first complete remission (��) prior to autologous stem cell transplant (ASCT) compared to all other patients (-?-?-). 4.