autologous blood and marrow transplantation - Blog Science ...

Elias et al.
tumor, or in the case of autograft contamination, the possibility of homing with
microenvironmental support for the tumor in local-regional sites. 4156
After conven­
tional-dose therapy, chest relapse is reduced from 90 to 60% with 50 Gy
radiotherapy. Thus, high-dose curative treatment approaches should include
radiotherapy to sites of bulk disease.
Much of the high dose SCLC experience just reviewed occurred during the
initial developmental phase of high-dose therapy for solid tumors. The majority of
trials employed either single high-dose chemotherapeutic agents (with or without
low dose agents in addition) (six trials; two with chest radiotherapy), 41,42,48-53
or
single alkylating agents (six trials; four with chest radiotherapy). 42,44
' 47,54-57
Combination alkylating agents were employed in a minority of patients (10 trials;
six with chest radiotherapy). 29
' 3243,58-64
405
Dosing was suboptimal compared with
modern standards. Treatment-related morbidity and mortality were higher than
currently expected.
DOSE INTENSITY: NEWER REPORTS USING CELLULAR SUPPORT
A number of new and updated experiences have been published since high-dose
therapy for SCLC was last reviewed and are summarized below. 46
In one study, six
of 10 partial responders with ED were transplanted with high-dose methotrexate
and etoposide after high-dose cyclophosphamide for mobilization. All achieved
near complete response but relapsed a median of 4 months later. Half had tumor
contamination of their peripheral blood progenitor cells (PBPC) documented while
in response. 53
In the updated Polish experience, six LD and 20 ED patients received two
cycles of high-dose cyclophosphamide and etoposide as induction followed by the
same drugs in six or with BCNU in 20. 63
Seven patients were already in complete
response and an additional seven of 18 achieved CR. Five patients remain
progression free 3 to 89 months later. Twenty-nine percent of complete responders
remained disease free >2 years. 63
Thirteen of 18 LD patients (72%) received high-dose ifosfamide, carboplatin,
and etoposide (ICE) with epirubicin as consolidation after two cycles of
mobilization chemotherapy. 64,65
Event-free survival was 69% (median follow-up
was 14 months). Nine (50%) remained progression-free. About 25% had stage I or
II SCLC, and surgical resection was performed in seven patients. None of the
PBPCs collected after the second cycle of mobilization chemotherapy contained
microscopic tumor cells as measured by immunocytochemistry using keratin and
ENM-125 antibodies. Further follow-up at 44 months had an event-free and overall
survival of 56%. 65
At the Dana Farber Cancer Institute and Beth Israel Deaconess Medical Center,
more than 55 patients with limited-stage and more than 30 with extensive-stage