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hanced, detection of initial failure in local-regional sites may increase. Enhanced survival by intensifying chest radiotherapy without significantly increasing the intensity of systemic therapy has recently been reported 30-33. Turrisi et al reported an 80% local control and a 56% actuarial survival at 2 years in 32 hrnited stage patients with cisplatin, etoposide and concurrent twice daily chest radiotherapy to 45 Gy 31. Preliminary analysis of an Eastern Cooperative Oncology Group trial appears to corroborate these findings and is the basis for an ongoing randomized trial comparing conventional daily vs the hyperfractionated chest radiotherapy 32. This study was designed to administer a dose-intensive multimodality approach utilizing maximum systemic therapy (combinations of alkylating agents) 33,34 with the addition of intensive local-regional radiotherapy to attempt to achieve local control. The therapy is associated with low morbidity and an acceptable mortality of 7%. Most patients were able to return to full-time work as few late complications were observed. Morbidity and mortality from high-dose chemotherapy is likely to decline further with the application of hematopoietic cytokines 35 and peripheral blood progenitor cells 36. For patients with responding extensive stage disease, a high rate of conversion to complete response was achieved. Our ability to consolidate sites of disease involvement with an additional modality (radiotherapy) is limited and its role remains to be defined. Despite this, two patients remain disease-free and the overall survival is not inferior to that expected from conventional therapy. More patients and longer followup is required to determine whether this approach provides meaningful long-term disease-free survival and whether certain subsets (eg, those with fewer sites of metastatic involvement or those with disease amenable to consolidative radiotherapy) have more favorable prognosis. For patients with responding limited stage disease, 45% (9 of 20), all in or near complete response prior to intensification, are enjoying prolonged and unmaintained disease-free survival. The results of this trial are sufficiently promising to spur the development of a randomized comparison between high dose and conventional dose therapy for limited stage patients in or near complete response to induction therapy. REFERENCES 1. Seifter EJ, Ihde DC. Therapy of Small Cell Lung Cancer: A Perspective on Two Decades of Clinical research. Semin Oncol 1988; 15(3):278-299. 2. Frei E III. Combination cancer chemotherapy: Presidential address. Cancer Res 1972; 32:2593-2607. 3. Frei E, Canellos GP. Dose: A critical factor in cancer chemotherapy. Am J Med 1980;69:585-591. 4. Elias AD, Ayash L, Frei E III, Skarin AT, Hunt M, Wheeler C, Schwartz G, Mazanet R, Tepler I, Eder JP, McCauley M, Herman T, Schnipper L, Antman KH. Intensive Combined Modality Therapy for Limited Stage Small Cell Lung Cancer. J Natl Cancer Inst (in press). 5. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Amer Stat Assoc 1958; 58:457-481. 6. Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. John Wiley & Sons, New York. 1980. pp 15,147. 7. Peto R, Peto J. Asymptotically efficient rank invariant test procedures. J Royal Stat 366 SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION
Soc, Series A. 1972; 135:185-198. 8. Cox DR. Regression models and life tables (with discussion). J Royal Stat Soc Series B 1972; 34:187-220. 9. Cornbleet M, Gregor A, Allen S, Leonard R, Smyth J. High dose Melphalan as consolidation Therapy for Good Prognosis Patients with Small Cell Carcinoma of the Bronchus (SCCB). Proc ASCO 1984:3:210. 10. Souhami RL, Hajichristou HT, Miles DW, Earl HM, Harper PG, Ash CM, Goldstone AH, Spiro SG, Geddes DM, Tobias JS. Intensive Chemotherapy with Autologous Bone Marrow Transplantation for Small Cell Lung Cancer. Cancer Chemother Pharmacol 1989; 24:321-325. 11. Banham S, Burnett A, Stevenson R, et al. Pilot Study of Combination Chemotherapy with Late Dose Intensification and Autologous Bone Marrow Rescue in Small Cell Bronchogenic Carcinoma. Br J Cancer 1982;42:486. 12. Banham S, Loukop M, Burnett A, et al. Treatment of Small Cell Carcinoma of the Lung with Late Dosage Intensification Programmes Containing Cyclophosphamide and Mesna. Cancer Treat Rev 1983;10(Suppl A):73-77. 13. Burnett AK, Tansey P, Hills C, et al. Haematologic Reconstitution Following High Dose and Supralethal Chemoradiotherapy using Stored Non-Cryopreserved Autologous Bone Marrow. Br J Haematol 1983;54:309-316. 14. Marangolo M, Rosti G, Ravaioli A, et al. Small Cell Carcinoma of the Lung (SCCL): High-Dose (HD) VP-16 and Autologous Bone Marrow Transplantation (ABMT) as Intensification Therapy: Preliminary Results. Int J Cell Cloning 1985;3:277. 15. Smith E, Evans BD, Harland SJ, et al. High-Dose Cyclophosphamide with Autologous Bone Marrow Rescue after Conventional Chemotherapy in the Treatment of Small Cell Lung Carcinoma. Cancer Chemother Pharmacol 1985; 14:120-124. 16. Klastersky J, Nicaise C, Longeval E, et al. Cisplatin, Adriamycin and Etoposide (CAV) for Remission Induction of Small-Cell Bronchogenic Carcinoma: Evaluation of Efficacy and Toxicity and Pilot Study of a "Late Intensification" with Autologous Bone Marrow Rescue. Cancer 1982;50:652-658. 17. Cunningham D, Banham SW, Hutcheon AH, et al. High-Dose Cyclophosphamide and VP-16 as Late Dosage Intensification Therapy for Small Cell Carcinoma of Lung. Cancer Chemother Pharmacol 1985;15:303-306. 18. Sculier JP, Klastersky J, Stryckmans P, et al. Late Intensification in Small-Cell Lung Cancer: a Phase I Study of High Doses of Cyclophosphamide and Etoposide with Autologous Bone Marrow Transplantation. J Clin Oncol 1985;3:184-191. 19. Spitzer G, Farha P, Valdivieso M, et al. High-Dose Intensification Therapy with Autologous Bone Marrow Support for Limited Small-Cell Bronchogenic Carcinoma. J Clin Oncol 1986;4:4-13. 20. Ihde DC, Diesseroth AB, Lichter AS, et al. Late Intensive Combined Modality Therapy Followed by Autologous Bone Marrow Infusion in Extensive Stage Small- Cell Lung Cancer. J Clin Oncol 1986;4:1443-1454. 21. Stahel RA, Takvorian RW, Skarin AT, Canellos GP. Autologous Bone Marrow Transplantation Following High-Dose Chemotherapy with Cyclophosphamide, BCNU, and VP-16 in Small Cell Carcinoma of the Lung and a Review of Current Literature. Eur J Cancer Clin Oncol 1984;20:1233-1238. 22. Stewart P, Buckner CD, Thomas ED, et al. Intensive Chemoradiotherapy with Autologous Marrow Transplantation for Small Cell Carcinoma of the Lung. Cancer Treat Rep 1983;67:1055-1059. 23. Humblet Y, Symann M, Bosly A, et al. Late Intensification Chemotherapy with Autologous Bone Marrow Transplantation in Selected Small-Cell Carcinoma of the Lung: A Randomized Study. J Clin Oncol 1987;5:1864-1873. 24. Pico JL, Baume D, Ostronoff M, et al. Chimiothérapie A Hautes Doses Suivie D'Autogreffe de Moelle Osseuse dans le Traitement du Cancer Bronchique a Petites SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 167
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Autologous Bone Marrow Transplantat
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CONTENTS nviAum TMLHTA'I OTT! 7 A l
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AUTOLOGOUS BONE MARROW TRANSPLANTAT
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TREATMENT OF NONSMALL CELL LUNG CAN
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SUMMARY OF THE NON HODGKIN LYMPHOMA
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Session I: Leukemia
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TRIAL PROGRESS The trial opened in
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Table 1. Achievement of Second Remi
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ALLOGENEIC VERSUS AUTOLOGOUS BONE M
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pts). The other 56 pts are too earl
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Figure 1 EORTC-GIMEMA AML 8 A EORTC
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PATIENTS AND METHODS Patients The B
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Thus, as the results of some ongoin
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COMPARISON OF INTENSIVE CONSOLIDATI
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over, 13 pts who had received ICC1
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Session II: Future Directions
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in a previous report 3 . Analysis a
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Engraftment of granulocyte, monocyt
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0.2 - 0.1 - ABMT with mAb purging f
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ENHANCED REGENERATION OF NATURAL KI
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RESULTS The in vivo immune effects
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16. Rizzoli V, Mangoni L, Carlo-Ste
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hydroperoxycyclophosphamide (4HC)-t
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survival in patients undergoing ABM
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IMMUNOTHERAPY OF AML AFTER ABMT - S
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Otherwise toxicity was mild to mode
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Therapy. Amsterdam Elsevier 1987;89
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200 IL6 in serum 44 SIXTH INTERNATI
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sodes), fewer days of i.v. antibiot
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Session III: Myeloma
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trary, in case of adequate collecti
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tion is considered, and all the mor
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Table 3: Cost effectiveness of high
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Session W: Lymphoma
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METHODS Selection of patients and t
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marrow treatment. Am J Med 85:829,1
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HIGH DOSE THERAPY WITH HEMATOPOIETI
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in TC 19 medium (Flobio), with an h
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progression for a long time after A
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Table 2. STATUS AT GRAFT Remission
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IL Figura 3 70 SIXTH INTERNATIONAL
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( 5 ) lowed by ABMT than refractory
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74 Figure 4 Low grade lymphoma - pr
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(range 15-55); 68 males and 32 fema
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our experience, this has a seven-ye
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30. Colombat P, Gorin NC, Lemonnier
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82 OVERALL SURUIWL from ABUT (accor
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PROGNOSTIC FACTORS IN ADVANCED STAG
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REFERENCES 1. Chopra R, Mc Millan A
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lished data to attempt to assess th
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1992;10:175-7. 3. McMillan A, Golds
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B. DAILY DAY AGENT DOSE -7 -6 -5 -4
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cohort with HR treated with BEC-2 i
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p R 0 P O R T I 0 N 1 0.9 0.8 0.7 0
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TABLE 3. TOXICITY BEC TAVe TMJ as 2
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ies. 10 Longer blood half-lives hav
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agents have been developed cautious
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Table 1. Radioisotopes for RIT. Pur
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The treatment criterion in this stu
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more than 80% of the cases. Patient
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Disease Free Survival 800 Time •
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Session VI: Breast Cancer
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achieved a complete remission survi
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acil, vincristine, prednisone (CMFV
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t: 3 en a in S « J •S •> c ai
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LONG TERM FOLLOW UP OF POOR PROGNOS
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tors both for progression-free surv
Page 148 and 149: 222 INDUCTION PHASE ESTROGEN RECEPT
Page 150 and 151: THE PHARMACOLOGY OF INTENSIVE CYCLO
Page 152 and 153: PK VARIABILITY OF CPA/CDDP/BCNU Whe
Page 154 and 155: 5. Groshow LB, Piantadosi S, Santos
Page 157 and 158: - Tn'üTiifi'.m'jii.'yjKJiHtyiwiT T
Page 159 and 160: normal CD34+ progenitor cells
Page 161 and 162: sequence analysis of the human haem
Page 163 and 164: Bielefeld, FRG) or control medium w
Page 165 and 166: 3. Koeffler HP, and Golde DW: Chron
Page 167 and 168: ply infected with supernatants from
Page 169 and 170: controls must be carefully matched
Page 171 and 172: Fig. IB: GPI isozyme analysis of 2
Page 173 and 174: PROCESSING OF STEM CELLS FOR TRANSP
Page 175 and 176: in progress using marker genes to l
Page 177 and 178: Table 1. Factors Affecting Quality
Page 179: Figure 2 .2 A Refractory/Relapsed L
Page 183 and 184: HIGH DOSE CHEMOTHERAPY IN GERM CELL
Page 185 and 186: carboplatin and etoposide with auto
Page 187 and 188: HIGH DOSE THERAPY IN GERM CELL TUMO
Page 189 and 190: Confusing data come out from early
Page 191: Session Mill: Lung Cancer
Page 194 and 195: Of the 14 limited stage patients in
Page 196 and 197: esponses with persistent nodular di
Page 200 and 201: Cellules. Bull Cancer 1987;74:587-5
Page 202 and 203: 30 36 42 48 54 60 66 72 78 84 12 18
Page 204 and 205: Table 2: Toxicity of CBP Regimen fo
Page 206 and 207: TREATMENT OF NONSMALL CELL LUNG CAN
Page 208 and 209: Table 1. Combination Chemotherapy R
Page 210 and 211: Table 6. Hematological Data of the
Page 212 and 213: ence in survival among the three hi
Page 215: Session IX: Ovarian Cancer
Page 218 and 219: lymph node involvement or parenchym
Page 220 and 221: higher frequencies of neurotoxicity
Page 222 and 223: 12. Ovarian Cancer Meta-Analysis Pr
Page 224 and 225: Table 2. Randomized Trials Employin
Page 226 and 227: BONE MARROW TRANSPLANTATION FOR OVA
Page 228 and 229: 1). Data from the survey was combin
Page 230 and 231: carboplatinum and ifosfamide. The s
Page 233: Session X: Sarcoma
Page 236 and 237: ated doses in a recent Pediatric On
Page 238 and 239: cytokines to reduce hospitalization
Page 240 and 241: TABLE 2 Dose Escalation Schedule Do
Page 243 and 244: CHRONIC MYELOGENOUS LEUKEMIA WITH B
Page 245 and 246: DISCUSSION In this study, the use o
Page 247 and 248: AUTOGRAFTING IN CHRONIC MYELOID LEU
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Table 1 Remission Deaths Graft Hema
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16 (800 mg/m2 per day for two conse
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Session XII: CNS
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1.2 Description of the study The tr
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3. Conclusion In conclusion, treatm
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3. Conclusion Hematological toxicit
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Session XIII: Peripheral Stem Cells
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Crouse, 1992). In the present repor
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with no evidence of systemic diseas
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Administration of rhSCF at doses of
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In summary, the ligand for c-kit ha
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AUTOGRAFTING WITH G-CSF-MOBILIZED B
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cells and CD34+ cells observed in t
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6. Brugger W, Bross K, Frisch J, et
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100 -l Collection Efficiency Figure
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MATERIALS AND METHODS PATIENTS. Pat
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None of the patients included in ar
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9. Aurer I, Ribas A, Gale RP. What
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246 o 0.6 b 0.1 B1 Figure 2 p = 0.0
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AUTOLOGOUS BONE MARROW TRANSPLANTAT
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SUMMARY OF THE NON HODGKIN LYMPHOMA
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SUMMARY: AUTOLOGOUS MARROW TRANSPLA
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mor. The obverse of this coin is po
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treated at Memorial Hospital in New
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Contributors and Participants Tause
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Leonard Kalman, Hematology/Oncology
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D.R. Sutherland, Oncology Research,
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