Autologous Bone Marrow Transplantation - Blog Science Connections

558 High-Dose Therapy of CHS Gliomas
of the CNS were a high priority for evaluation. This report details our
experience treating CNS tumors with high-dose chemotherapy and autologous
bone marrow transplantation (ABMT).
MATERIALS AND METHODS
Institutions
Patients were treated at the following medical centers: Baylor University
Medical Center, Dallas, TX; Case Western Reserve University, Cleveland, OH;
Cleveland Clinic Foundation, Cleveland, OH; The University of Texas Health
Science Center at San Antonio, San Antonio, TX; Vanderbilt University,
Nashville, TN; and Washington University, St. Louis, MO. Prior to treatment,
patients gave their informed consent as approved by the individual institutional
review board.
Bone Marrow Harvest, Cryopreservation, and Reinfusion
Bone marrow collection, processing, cryopreservation, storage, and
reinfusion were performed as previously reported (3). The minimum
required cell dose per transplant was greater than 1.0 x 10 8 /kg of body mass.
Evaluation Definitions
Tumor response was evaluated by the criteria of Wilson et al. (4). A
response required improvement evident on a clinical neurologic examination
concomitant with a completed tomography scan of the head demonstrating
less tumor enhancement and mass effect while the patient was on a stable or
decreasing dose of corticosteroids. Patients who died of therapy-related
toxicity were analyzed as having progressive tumor at the date of death.
Survival and response durations were calculated from the date of bone
marrow transplantation for phase 1 and II studies and from the date of
diagnosis for phase III studies.
Statistical Analysis
Actuarial survival rate was calculated by the product-limit method of
Kaplan and Meier (5). Confidence-limit intervals were calculated as described
by Simon (6).
Chemotherapy
Three agents, BCNU (carmustine), VP-16-213 (etoposide), and thio-
TEPA, were evaluated in phase I and II studies. Each was administered as
three equal daily infusions followed in 3 or 4 days by ABMT. The combination
of carmustine and etoposide was administered as a 6-day course, 3 days of
carmustine followed by 3 days of etoposide. Carmustine was also evaluated
adjuvantly in a phase 111 study. The results of these studies are shown in
Tables 1 and 2.