Autologous Bone Marrow Transplantation - Blog Science Connections

554 High-Dose Carmustine and Transplantation for Gliomas
not give any specific information, and no criterion for a hypereosinophilic
syndrome was found.
Other Toxicities
Irradiation was done as scheduled for 11 patients (2 patients in relapse
had had anterior irradiation, and 2 patients could not tolerate the scheduled
radiotherapy course). The patients' treatment tolerance was very good, and
the classical cerebral edema often present at the beginning of treatment
could be controlled readily with appropriate medications. However, one
patient died 3 days after the end of the radiotherapy course in a sudden coma;
the autopsy showed a cerebral hemorrhage, when platelet count was normal;
the remaining part of the tumor was completely necrotic and no cerebral
edema was found. This type of complication is well known and classical in
cerebral irradiation.
No major problems were recorded in the majority of patients after surgery,
but this probably reflects a bias in selection of patients, who entered this
protocol only when their performance status was good. One patient,
however, became comatose and died of an immediate postoperative
extradural hematoma.
Altogether, three deaths (20%) of toxic reactions at 2, 3, and 6 months
after completion of the whole treatment protocol were recorded. Only one
(7%) was directly consecutive to the high dose of carmustine.
Response
As of November 15,1986, the median follow-up has been only 4 months,
and only the feasibility of the protocol is reported here in detail.
All patients, except three who died of toxic effects, had at least the same
performance status before and after treatment (1 -1), and four patients initially
scored as having grade 2 status became grade 1 after treatment.
Histologic assays of the four patients treated with surgery after high-dose
carmustine, showed remaining neoplastic cells. Even if complete remission
was not fully achieved after the high-dose chemotherapy, however, additional
tumor reduction as a result of spontaneous necrosis has been observed. In
the patient who died of cerebrospinal hemorrhage, no residual tumor cells
were noticed at autopsy.
The 15 patients' survival is plotted in Figure 1. In addition to the three
patients who died, one patient has been in relapse, as shown by CT scan
changes, since day 90. The other patients are alive, disease-free, and have a
stable performance status.
DISCUSSION AND CONCLUSION
The objective of this pilot study was to evaluate the feasibility, efficiency,
and tolerance of a new protocol combining surgery, conventional poly-