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

INTENSIVE COMBINED MODALITY THERAPY FOR RESPONDING
SMALL CELL LUNG CANCER
Anthony D. Elias, M.D.
Lois Ayash, M.D.; Emil Frei III, M.D.; Arthur T. Skarin, M.D.; Cathy Wheeler,
M.D.; Gary Schwartz, M.D.; Rosemary Mazanet, M.D.; Isidore Tepler, M.D.;
Mary McCauley, R.N.; Lowell Schnipper, M.D.; Karen H. Antman, M.D.
From the Departments of Medicine, Dana-Farber Cancer Institute and Beth
Israel Hospital Harvard Medical School Boston, MA.
Address reprint requests to Dr. Anthony Elias,
DFCI, 44 Binney St., Boston, MA 02115.
Supported in part by a grant from the Mathers Foundation and by Public
Health Service Grant
CA13849 from the National Cancer Institute, National Institutes of Health,
Department of Health and Human Services. ADE, LA, GS, and RM are recipients
of American Cancer Society Career Development Awards. EF HI is the Richard
and Susan Smith Professor of Medicine.
Much appreciation to Elaine Reich and the nurses on 12W at the DFCI and
the nurses on 4S at the Beth Israel, and to Julie Durmis & Diane Warren for excellent
data management.
ABSTRACT
Standard dose chemoradiotherapy for SCLC has achieved high response
rates but rare long term survivors. Dose intensification using autologous bone
marrow support (ABMT) has increased the complete responses without clearly
documenting an overall survival benefit. These trials generally used single alkylating
agents with inconsistent application of chest irradiation leading to high
local relapse rates.
Unique to this trial is the use of high dose combined alkylating agents, cyclophosphamide,
carmustine and cisplatin (CBP), followed by CH 50-56 Gy,
prophylactic cranial & involved field radiotherapy in patients responding to
conventional dose chemotherapy. Patients with histologically documented limited
or extensive stage in response to first line chemotherapy were eligible.
As of April 1992,30 patients have been treated: 20 with stage III limited disease
(7 complete (CR), 13 partial (PR) responders prior to ABMT), and 10 with
extensive stage disease (2CR, 8PR prior to ABMT). Two patients died from Candida.
Of 16 patients evaluable for response, 11 (69%) converted from partial to
complete response.
For Hmited disease, post ABMT, unmaintained median event-free survival
and survival were 16 and 17 months. For extensive disease, post ABMT,
unmaintained median event-free survival and survival were 10 and 13 months.
Actuarial 2-year survival was 47% & 14% for limited and extensive disease, respectively,
with 3 patients, two with limited and one with extensive disease followed
for over 5 years.
SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 161