HIGH-DOSE CHEMOTHERAPY WITH AUTOLOGOUS TRANSPLANTATION FOR PERSISTENTRELAPSED OVARIAN-CANCER - A MULTIVARIATE-ANALYSIS OF SURVIVAL FOR 100CONSECUTIVELY TREATED PATIENTS/

Purpose: To examine the prognostic factors associated with prolonged p rogression-free survival (PFS) and overall survival (OS) in 100 consec utively treated women undergoing autologous stem-cell transplant for a dvanced ovarian cancer. Patients and Methods: From October 1989 to Feb ruary 1996, we transplanted 100 patients with ovarian cancer following chemotherapy with high-dose carboplatin, mitoxantrone, and cyclophosp hamide with or without cyclosporine (n = 70); melphalan and mitoxantro ne with or without paclitaxel (n = 25); or other regimens (n = 5). The ir median age was 48 years (range, 23 to 65), 70% had papillary serous histology, 72% had grade III tumors, 66% were platinum-resistant, and 61% had greater than or equal to 1 cm bulk. The median number of prio r regimens was two (range, one to six). Univariate and multivariate an alyses were performed to examine age (< v greater than or equal to mea n), stage, initial bulk, histology, grade, response to initial therapy , number of prior regimens, time from diagnosis to transplant, transpl ant regimen, platinum sensitivity, and bulk (< v greater than or equal to 1 cm) at transplant. Results: The median PFS and OS times for the 100 patients were 7 and 13 months. A stepwise Cox proportional hazards model identified tumor bulk (P = .0001), and cisplatin sensitivity (P = .0249) as the best predictors of PFS. Age (P = .0017), bulk at tran splant (P = .0175), and platinum sensitivity (P = .0330) provided the best prediction of OS. The median PFS and OS times for the 20 patients with platinum-sensitive, less than or equal to 1-cm disease were 19 a nd 30 months. No differences in OS were seen when chemotherapy or surg ery was used to achieve a minimal disease state. Conclusion: Before co nsideration of high-dose therapy for recurrent/persistent advanced ova rian cancer. patients should undergo debulking surgery or chemotherapy to achieve a minimal disease state. patients with platinum-resistant, bulky disease should not be transplanted. The optimal patients for th is therapy may be those with minimal disease responsive to initial che motherapy. (C) 1997 by American Society of Clinical Oncology.