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

Of the 14 limited stage patients in or near CR, 9 (64%) remain disease free at
a median 24 (1276+) months followup. Relapse was primarily in sites of prior
involvement and within the first year, but one patient died of adenosquamous
lung cancer. Of the 7 ED pts in or near CR, 2 (29%) remain disease free at a median
10 months followup and one patient is alive with disease at 65 months.
The unmaintain remission and survival post ABMT appears favorable, particularly
in those patients with an excellent preABMT response, compared with
that expected from conventional chemoradiotherapy. Additional patients and
further followup are needed to evaluate its utility in extensive disease in excellent
response. For limited stage patients in or near complete response, a randomized
comparison between this approach and conventional dose therapy is being
developed.
INTRODUCTION
SCLC is a tantalizingly resistant solid tumor to chemoradiotherapy.
Chemoradiotherapy at conventional doses has resulted in high response rates:
80-100% (50-70% complete) for disease limited to the chest, and 60-80% (20-40%
complete) for metastatic disease 1. However, cure is elusive. Median survival of
14-18 months for limited disease and 8-12 months for extensive disease are
achieved. About 20% of limited stage and 5% of extensive stage patients will
survive two years. Survival beyond 5 years occurs in 3-8% of patients with
SCLC 1.
The inability to destroy the residual cells despite "chemosensitivity" suggests
the existence of a tumor stem cell resistant to cytotoxic therapy. Maximizing
dose and dose intensity to the limits of acceptable toxicity might overcome
resistance 2,3. Hematopoietic stem cell support, using marrow or peripheral
blood progenitor cells, provides the opportunity to evaluate dose-response to
the hmits of organ tolerance.
This phase II trial was designed to determine the disease-free & overall survival
of patients with SCLC responding to conventional dose chemotherapy following
treatment with high dose combined alkylators (cyclophosphamide,
cisplatin and carmustine) and radiotherapy, to ascertain the subset of patients
most likely to benefit and to evaluate the toxicity associated with this therapy.
The first 19 patients with limited stage disease have been previously described 4.
METHODS
Adult patients aged 18 to 59 with histologically documented small cell lung
cancer, responding to first line conventional dose induction chemotherapy, were
eligible for this study. At the time of high dose chemotherapy, patients were required
to have a performance status of 0-1, with leukocytes >3000/ul, platelets
>100,000/ ul, creatinine clearance > 60 cc/min and SGOT and bilirubin < 1.5 x
normal and no active tumor involvement of the brain or marrow. Pulmonary
function had to be > 60% of predicted (FVC, DLCO corrected for hemoglobin)
were required. Written informed consent was obtained.
The treatment schema is outlined in Figure 1. As patients were usually referred
after initiation of induction therapy, no specific induction chemotherapy
was required. After maximal response from induction chemotherapy (generally
~4 cycles), eligibility was determined with restaging studies including head,
262 SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION