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Autografting

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

Bone Marrow Transplantation volume 26, pages 153–160 (2000)Cite this article

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. Bone Marrow Transplantation (2000) 26, 153–160.

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Acknowledgements

Vassilios Papadakis was supported in part by the Greek Children's Fund at Memorial Sloan-Kettering Center.

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Authors and Affiliations

  1. Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    V Papadakis & IJ Dunkel

  2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    LD Cramer

  3. Department of Neurology, Cooper Hospital, Camden, NJ, USA

    E Kramer

  4. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    E Papadopoulos

  5. Department of Pediatrics, University of Chicago, Chicago, IL, USA

    S Goldman

  6. Department of Neurology, Children's National Medical Center, Washington, DC, USA

    RJ Packer

  7. Department of Oncology, Princess Margaret Hospital for Children, Perth, Australia

    M Willoughby & D Baker

  8. Department of Pediatrics, New York Presbyterian Hospital, New York, NY, USA

    J Garvin

  9. Department of Pediatrics, East Carolina University, Greenville, NC, USA

    S Strandjord

  10. Department of Pediatrics, University of Nebraska, Omaha, NE, USA

    P Coccia

  11. Department of Neurology, Phoenix Children's Hospital, Phoenix, AZ, USA

    AM Kaplan

  12. Department of Pediatrics, All Children's Hospital, St Petersburg, FL, USA

    M Klemperer

  13. Stephen D Hassenfeld Children's Center for Cancer and Blood Disorders, New York University Medical Center, New York, NY, USA

    JL Finlay

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Papadakis, V., Dunkel, I., Cramer, L. et al. High-dose carmustine, thiotepa and etoposide followed by autologous bone marrow rescue for the treatment of high risk central nervous system tumors. Bone Marrow Transplant 26, 153–160 (2000). https://doi.org/10.1038/sj.bmt.1702475

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