HIGH-DOSE CARBOPLATIN, THIOTEPA, AND ETOPOSIDE WITH AUTOLOGOUS STEM-CELL RESCUE FOR PATIENTS WITH RECURRENT MEDULLOBLASTOMA

Purpose: Medulloblastoma is a highly lethal disease when it recurs. Ve ry few patients survive with conventional treatment, This study evalua ted the use of high-dose carboplatin, thiotepa, and etoposide with aut ologous stem-cell rescue (ASCR) in patients with recurrent medulloblas toma. Methods: Chemotherapy consisted of carboplatin 500 mg/m(2) (or a rea under the curve = 7 mg/mL.min via Calvert formula) on days -8, -7, and -5; and thiotepa 300 mg/m(2) and etoposide 250 mg/m(2) on days -5 , -4, and -3; followed by ASCR on day 0. in addition to the study-pres cribed therapy, 21 patients received other treatment: neurosurgical re section in seven, conventional chemotherapy in 17, and external-beam i rradiation in 11 cases. Results: Twenty-three patients with recurrent medulloblastoma, aged two to 44 years (median, 13 years) at ASCR, were treated. Three patients died of treatment-related toxicities within 2 1 days of ASCR; multiorgan system failure in two, and Aspergillus infe ction with venoocclusive disease in one. Seven of 23 patients (30%) ar e event-free survivors Pat a median of 54 months post-ASCR (range, 24 to 78 months). Kaplan-Meier estimates of event-free (EFS) and overall survival are 34% +/- 10% and 46% +/- 11%, respectively, at 36 months p ost-ASCR. Conclusion: This strategy may provide long-term survival for some patients with recurrent medulloblastoma (C) 1998 by American Soc iety of Clinical Oncology.