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Safety and efficacy of high-dose chemotherapy with autologous
stem cell transplantation for patients with malignant astrocytomas
Chen B, Ahmed T, Mannancheril A, Gruber M, Benzil DL
Department of Neurosurgery, New York Medical College, Valhalla,
New York 10595, USA.
Background.
Malignant
astrocytomas are among the most resistant tumors to curative treatments.
Mean
survival without treatment is measured in weeks, and even with maximal surgery
and radiation, the mean reported survival is < 1 year.
The advent of
supportive treatments and newer agents has resulted in benefits for many
patients with cancer.
The authors investigated the safety and effect on survival
of a high-dose thiotepa and carboplatin regimen with autologous stem cell
transplantation (ASCT) in patients with malignant astrocytomas who were enrolled
in a prospective trial approved by an institutional review board (IRB).
Methods.
Twenty-one
patients were enrolled in an IRB-approved, prospective trial.
After baseline
testing was completed, patients underwent peripheral stem cell mobilization with
cyclophosphamide (4 g/m2) and etoposide (450 mg/m2) followed by
granulocyte-colony-stimulating factor (10 microg/kg).
Peripheral stem cells were
harvested when leukocyte counts recovered.
Patients received 2 cycles of
thiotepa (750 mg/m2) and carboplatin (1600 mg/m2) followed by infusion of the
preserved stem cells.
The cycles were administered 6-10 weeks apart.
Primary
outcome measures were patient survival (Kaplan-Meier analysis) and treatment
toxicity (using National Cancer Institute common toxicity criteria).
Results.
Autologous stem
cells were harvested effectively and transfused in all patients.
Kaplan-Meier
survival analysis demonstrated a survival time of 34.3 +/- 5.5 months (range,
9-94 months).
Despite significant myelosuppression, only three patients
experienced Grade 4 complications and eight experienced Grade 3
complications.
Conclusions.
High-dose
chemotherapy with thiotepa and carboplatin with concomitant ASCT was used safely
to treat patients with malignant astrocytomas and may provide a survival
advantage.
Copyright 2004 American Cancer Society.
PMID: 15139065 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15139065
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