HIGH-DOSE CHEMOTHERAPY WITH AUTOLOGOUS PERIPHERAL STEM-CELL SUPPORT IN ADVANCED OVARIAN-CANCER

Twenty patients with advanced (stage Ill-IV), previously untreated ova rian carcinoma were treated by: (a) induction chemotherapy (40 mg/m(2) cisplatin, days 1-4; 1.5 g/m(2) cyclophosphamide, day 4; every 4 week s for two cycles) followed by (b) intensification chemotherapy (100 mg /m(2) cisplatin, day 1;650 mg/m(2) etoposide, day 2; 1.8 g/m(2) carbop latin, day 3). Eligibility criteria further included: age less than 55 years, moderately good to poor tumour grade, macroscopic (>0.5 cm) re sidual tumour. Autologous peripheral stem cells were recruited after t he induction cycles and, to ensure haematological support, autologous bone marrow harvesting was routinely performed in the first 14 cases. Haematological support consisted of autologous peripheral stem cells a nd autologous bone marrow transplant in 16 and four patients, respecti vely. All patients are evaluable for toxicity and 19 for pathological response, one being dead of systemic mycosis 35 days after the autolog ous bone marrow transplant. Severe extra-haematological toxicities wer e the following: gastrointestinal (100%), neurological (10%), hepatic (10%). Pathological response was detected in 84% of cases (CR 37%, mic roscopic PR 26%, macroscopic PR 21%). Median follow-up times of 48 and 41 months have been reached respectively from enrolment and second-lo ok. Four-year 62% overall and 57% progression-free survivals have been reached. Ten patients are still alive with NED (six of seven with CR, three of five with microscopic PR, and one of four with macroscopic P R). Autologous peripheral stem cell transplant significantly reduced t he duration of aplasia compared with autologous bone marrow transplant , and toxicity was proved to be manageable in those patients undergoin g autologous peripheral stem cell transplant. The prolonged disease-fr ee survival in patients showing CR and microscopic PR suggests that fu rther investigation on this new approach is worthwhile.