Autologous Bone Marrow Transplantation - Blog Science Connections

ABMT in Melanoma 533
Table 1. Three Drugs and Autologous Bone Marrow Transplantation for
Advanced Melanoma
Drug"
No. of
Response
Patients CR (%) PR (%) Total (%)
Carmustine
Prior Rx 15 0 2 (13) 2 (13)
No prior Rx 16 4 (25) 8 (50) 12 (75)
Total 31 4 (13) 10 (32) 14 (45)
Melphalan
Prior Rx 16 3 (19) 7 (44) 10 (63)
No prior Rx 10 3 (30) 5 (50) 8 (80)
Total 26 6 (23) 12 (46) 18 (69)
Thio-TEPA
Prior Rx 12 1 (8) 6 (50) 7 (58)
No prior Rx 15 3 (20) 7 (47) 10 (67)
Total 27 4 (15) 13 (48) 17 (63)
"Carmustine, 1200 mg/m 2 ; melphalan, 180-225 mg/m 2 ; thio-TEPA, 900-1575 mg/m 2 .
Note: Prior Rx is for patients who received prior therapy before autografting; no prior
Rx is for patients who received no therapy before autografting.
accounted for by the significantly poorer response in patients who had
received previous therapy (13% for carmustine compared to 63% and 58% for
melphalan and thio-TEPA, respectively, P < .02). In patients who had not
received previous therapy before autografting, there were excellent responses
with all three agents. The effect of the extent of metastases in which patients
with visceral metastases are compared with patients with skin and/or lymph
node disease (see Table 2).
The response rates for high-dose carmustine (45%), melphalan (69%),
and thio-TEPA (63%) are compared with the responses seen with each of
these agents used in conventional doses for advanced melanoma (Table 3).
In each instance, the response is significantly greater for the high dose with
autografting (P < .05 by confidence interval). The median duration of
response was similar for all three agents: carmustine, 6 months (range,
2-46+ months); melphalan, 4 months (range, 2-14 months); thio-TEPA, 4
months (range, 2-15+ months). However, twice as many patients treated with
carmustine had unmaintained responses greater than 1 year compared with
patients who received melphalan (15% versus 8%). Patients who received
thio-TEPA have been most recently treated, with seven of 17 patients still alive
and only one more than 1 year.
Since there were no overlapping toxicities between the high-dose
melphalan and carmustine studies, and since both agents demonstrated