VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

Intensive hydration to maintain high urine output was started 24 hours
prior to intensification chemotherapy and continued for one week. Cyclophosphamide
was infused intravenously over one hour on days 1,2, and 3.
Etoposide was infused over four hours every 12 hours on days 1,2, and 3.
Cisplatinwas administered over 2 hours on days 1,2, and 3.
RESULTS
Response
Seventy-seven patients had measurable or assessable disease at the time of
intensification. Three patients had no evidence of disease (NED) after surgical
resection, these were not assessable for response to induction.
Seventy-nine patients were treated with median 4 cycles of induction chemotherapy
(77 patients with measurable disease and two NED patients). Seventy-nine
percent (79%) received Adriamycin-based induction chemotherapy.
Twenty-one percent (21%) were treated with Methotrexate chemotherapy combinations.
Seven patients suffering early death during the intensive phase were considered
treatment failures and scored as treatment related early deaths. Median duration
of follow-up for the entire group of 80 patients is 83+ weeks (range, 13-
283+). Median duration of follow-up for the 24 surviving patients is 172+
weeks(range 74+-283+).
Response to induction chemotherapy was 77%. Thirty-one percent (31%)
were complete responders and 46% were partial responders. Twenty-three percent
(23%) had nonresponsive stable disease.
The "overall response" was defined as response in those patients with measurable
disease who completed both induction and intensive phases. The three
NED patients were censored from response evaluation. The "overall response"
was 79%. Complete remission in 55% and partial response in 25%. Thirty-seven
percent 37% of partial responders and 33% of stable disease patients to induction
chemotherapy were converted to complete remission after the intensive
phase.
Median progression-free survival measured from beginning induction
therapy is 50 weeks (95% confidence interval, 44 to 61 weeks)(Fig. 2). Median
survival is 83 weeks (95% confidence interval, 68 to 110 weeks) (Fig. 3). Patients
followed long term show that the progression-free interval and overall survival
curves have reached a plateau after 142 weeks (2.7 years) and 180 weeks (3.5
years) respectively, persisting at greater than 5 year follow-up. Characteristics of
patients constituting the tail of the progression-free interval and survival curves
reveal predominately one or two sites of parenchymal lung or regional nodal
relapse at the time they started induction chemotherapy.
Using univariate analysis, four features predicted for improved progression-free
survival or overall survival. These include: (1) disease site distributed
to lung or regional lymph nodes (P=.093 and .007); (2) one disease site (P=.030
and .006); (3) disease-free interval (DFI) from diagnosis to detection of metastasis
of greater or equal to 1 year (P=.038 and .042); (4) response to induction chemotherapy
with complete response or no evidence of disease (P=.011 and .037).
By multivariate analysis five variables were significant "negative" predic-
Sixm INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 119