High-dose carmustine, thiotepa and etoposide followed by autologous bone marrow rescue for the treatment of high risk central nervous system tumors Journal Article

  

Authors:	Papadakis, V.; Dunkel, I. J.; Cramer, L. D.; Kramer, E.; Papadopoulos, E.; Goldman, S.; Packer, R. J.; Willoughby, M.; Baker, D.; Garvin, J.; Strandjord, S.; Coccia, P.; Kaplan, A. M.; Klemperer, M.; Finlay, J. L.
Article Title:	High-dose carmustine, thiotepa and etoposide followed by autologous bone marrow rescue for the treatment of high risk central nervous system tumors
Abstract:	Forty-two patients (29 newly diagnosed) with high grade gliomas (n = 37), medulloblastoma (n = 2) or non-biopsied tumors (n = 3) with supratentorial (n = 24), brain stem (n = 11), posterior fossa (n = 5) or spinal (n = 2) location were eligible for this study with adequate organ function and no bone marrow tumor infiltration. Median patient age was 12.2 years (range, 0.7-46.8). A total of 600 mg/m2 BCNU, 900 mg/m2 thiotepa and 1500 or 750 mg/m2 etoposide (VP-16) was administered followed by autologous bone marrow reinfusion (ABMR). Twenty-one newly diagnosed patients received local irradiation (RT) post ABMR. Nine early deaths were observed (21%), as well as one secondary graft failure. Half of the patients aged 18 years or older experienced toxic deaths, whereas only 15% of patients younger than 18 years experienced toxic death (P = 0.05). Of 25 evaluable newly diagnosed patients, 20% achieved complete remission (CR) and 4% partial remission (PR), while 28% remained in continuing complete remission (CCR) and 44% remained with stable disease prior to RT. Of eight evaluable patients with recurrent disease, one achieved CR and two PR, while one remained in CCR and four with stable disease for 1 to 110.2 months. Overall survival was 36%, 24% and 17% at 1, 2 and 3 years following ABMR, with three newly diagnosed patients and one patient treated for recurrent disease being alive, without disease progression 64.4, 67.0, 86.3 and 110.2 months after ABMR, respectively. The combination of high-dose BCNU/thiotepa/VP-16 has substantial toxicity but definite activity for high risk CNS tumors. Similar protocols with lower toxicity merit further evaluation in both newly diagnosed and recurrent CNS tumors.
Keywords:	adolescent; adult; cancer survival; child; clinical article; treatment outcome; child, preschool; disease-free survival; middle aged; survival rate; diarrhea; side effect; combined modality therapy; neurotoxicity; glioma; lung toxicity; nephrotoxicity; etoposide; mucosa inflammation; stomatitis; antineoplastic combined chemotherapy protocols; cancer mortality; carmustine; thiotepa; central nervous system tumor; high risk patient; central nervous system neoplasms; abdominal pain; fever; infant; cardiovascular disease; cancer infiltration; medulloblastoma; spinal cord tumor; remission; recurrent disease; liver diseases; nitrosourea; pancytopenia; seizure; dermatitis; graft survival; bone marrow transplantation; brain stem tumor; hallucination; transplantation, autologous; hemiparesis; multiple organ failure; hematologic diseases; posterior cranial fossa tumor; autologous bone marrow transplantation; lung diseases; liver venoocclusive disease; nervous system diseases; bone marrow metastasis; cns tumors; kidney diseases; humans; human; male; female; priority journal; article
Journal Title:	Bone Marrow Transplantation
Volume:	26
Issue:	2
ISSN:	0268-3369
Publisher:	Nature Publishing Group
Date Published:	2000-07-01
Start Page:	153
End Page:	160
Language:	English
PUBMED:	10918425
PROVIDER:	scopus
DOI:	10.1038/sj.bmt.1702475
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-0033931520&partnerID=40&md5=271e044ec6d6b90ed81d07ec4753b51d
Notes:	Export Date: 18 November 2015 -- Source: Scopus

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